reVision Small Group Signup Survey

By completing the form below, you are signing up to be included in a reVision small group.  You will be placed into a small group based on the availability preferences you select below, combined with other demographic criteria.  The objective is to create diversity in each small group.  Once you have been assigned to a small group, the meeting time and location for that group will be communicated to you.  Meeting time and location issues will be addressed at that time. 

Name:

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* 1. Name:

Email Address:

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* 2. Email Address:

Phone  Number:

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* 3. Phone  Number:

Gender:

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* 4. Gender:

Age:

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* 5. Age:

Meeting Time Preferences (you may select more than one):

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* 6. Meeting Time Preferences (you may select more than one):

Small group participants will be required to purchase a book to be used as a part of the program.  The book will cost approximately $10.  Will the cost of the book present a financial hardship for you?

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* 7. Small group participants will be required to purchase a book to be used as a part of the program.  The book will cost approximately $10.  Will the cost of the book present a financial hardship for you?

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