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* 1. Your Name:

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* 2. Email Address:

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* 3. Phone Number:

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* 4. Please check which meeting format you prefer:

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* 5. I am willing to facilitate sessions for my small group (generating discussion, ensuring flow of the meeting, communications, etc). Don't worry, we'll train you! 

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* 6. I am willing to host a small group in my home. 

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* 7. Please check all that apply. *If you do not already have a group, please enter your top three meeting dates/times in questions 8-10.

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* 8. Please indicate your FIRST CHOICE for meeting dates/times below. Please include day of the week and meeting time. 

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* 9. Please indicate your SECOND CHOICE for meeting dates/times below. Please include day of the week and meeting time.

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* 10. Please indicate your THIRD CHOICE for meeting dates/times below. Please include day of the week and meeting time.

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