Group Name * |
|
Area Served |
|
Primary Contact
|
First |
|
Last* |
|
Address |
|
City |
|
State |
|
Zip Code |
|
Primary Phone |
|
E-Mail*
|
|
Other Contact
|
First |
|
Last |
|
Address |
|
City |
|
State |
|
Zip Code |
|
Primary Phone |
|
E-Mail
|
|
Reunion Group Information
|
Meeting Day |
|
Time
|
|
Frequency (weekly, 1st and 3rd Tuesday, etc.) |
|
Our Group is
|
|
Meeting Place |
|
Location of Meeting Place
|
|
Are others available to join your group?
|
Yes No |
Are you willing to train new group leaders?
|
Yes No |