Exit this survey >> Theresian Interest Form 1. Default Section Question Title Question Title * 1. Your name: Question Title * 2. Acadiana Area Theresians will not share this information with anyone.What day of the week is good for you to meet? First Choice: Second Choice: Question Title * 3. What part of the day are you available to meet for 2 - 3 hours? Morning (Between 8:00 a.m. and 12:00 a.m.) Afternoon (Between 12:00 a.m. and 5:00 p.m.) Evening (Between 5:00 p.m. and 9:00 p.m.) Question Title * 4. To which church/parish do you belong? Question Title * 5. How many miles are you willing to travel to meet with your community once a month? Question Title * 6. Do you have your own reliable transportation? Yes No Question Title * 7. Please type your email address in the box below so we may contact you. Your email address will be kept confidential. Question Title * 8. List alternate ways in which we may contact you. Home Phone Cell Phone Work Phone Question Title * 9. Questions and/or comments: Done >>