1. Default Section

* 1. I am:

* 2. Age:

* 3. Sex:

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

* 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):

* 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:

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

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

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

T