Wufoo

Core Group Info Request Form

Name *
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Daytime Phone ### - ### - ####
Evening Phone * ### - ### - ####
Email *
What type of Core Group are you interested in connecting with? *
Married Couples Singles Mens Womens Mixed
What age group? *
18-Early 20's 20's-30's 30's-40's 40's-50's 50's-60's 60's+
What day(s) of the week are you able to meet? *
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Have you ever been part of a small group? *
Yes No
If yes, were you a
Member Leader/Facilitator
Do Not Fill This Out