The information you provide in this survey will help inform your small group pairings. 

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* 1. Please provide your first and last name

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* 2. Email

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* 3. Phone number

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* 4. Age

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* 5. Are you single or married?

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* 6. Do you have children? (Check any that apply)

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* 7. Would you be willing to organize the first meet up for your "Better Together" small group?

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* 8. What are you hoping to take away from this experience?

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* 9. Do you have specific areas of interest or desired topics for your small group? 

0 of 9 answered
 

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