NAME *

First Name

Last Name

PHONE *

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ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

My name and/or contact information has changed.

PICK YOUR GROUP *

Mondays, 7:30 – 9:00p – Mom’s Group (Meridian-Kessler)

Wednesdays, 11:30a - 1:00p (Meridian-Kessler)

Wednesdays, 7:00 – 9:00p (Downtown)

Thursdays, 7:00 - 9:00p (Irvington)

INVESTMENT *

I am a sustaining member ($30+ per month).

I will contribute online.

I will bring a check to the first meeting.

I'd like to use the Scholarship Fund this round.

I'm just checking this out for a week.

HOSTING

I am open to hosting and can do so...

Every week

Every other week

1-2 times

FACILITATION

I am interested in learning how to co-facilitate a group.