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1. Your Contact Information (Required.)

First Name *

Last Name *

Your Role

Church Name

City/Town

State/Province

Email Address *

Phone Number *

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2. What is your average adult attendance?

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3. How many groups do you currently have? (All Types: home groups, classes, Celebrate Recovery, etc,)

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4. What issues or problems would you like to discuss?

1.

2.

3.

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5. Are you a robot? Type Yes or No (Required.)