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1. Default Section

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* 1. I am:

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* 2. Age:

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* 3. Sex:

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* 4. Please check your preferred dates and times for meetings. Check any that would work for you:

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* 5. Rate these meeting topics in order of interest:

  Not interested Slightly interested Pretty interested Very interested
ADDults in Career and Workplace Development
ADDults and Family Issues (Being a better parent )
ADDults and Marriage or Relationships
ADDults and Forms of Treatment
ADDults and Types of Treatment
ADDults and Time Management Techniques
ADDults and Addictions
ADDults and School issues (College & Adolescent Grades )
Other (Please describe):

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* 6. If you can suggest a better location for future meetings, please describe this site, and provide any contact information you might have for booking the location:

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* 7. Would you be willing to lead a group discussion on a topic of interest?

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* 8. Preferred length of time to allow for meetings:

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* 9. Please add any other questions or comments you might have:

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