We are looking forward to connecting with you. Please take a moment to tell us what you're interested in, and how and when we can best serve you.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address:

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* 4. Best number to contact you:

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* 5. I am interested in workshops/groups in the following areas:
(check all that apply)

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* 6. The best time for me to participate in a workshop/group is:
(check all that apply)

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* 7. I would use childcare (for a fee) on Sunday afternoon, evenings or Wednesday evenings.

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