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Primary Registrant Section
Fill this out for the Main Registrant
First Name *
Your answer
Last Name *
Your answer
E-Mail *
Please add your email address; if you have no email, just enter the word NONE
Your answer
Cell Phone *
Your answer
Spouse Registrant Section
Fill this out if you want to register your spouse with you.
Day & Time choices will be the same.
If you want different day or time for either spouse, fill out a separate form.
Spouse First Name
Your answer
Spouse Last Name
Your answer
Spouse E-Mail Address
Your answer
Spouse Cell Phone
Your answer
Required for ALL Registrations
Home Phone
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Type of Group You Want to Participate In *
Do You Want to Participate with your Pre-Teen Children as a Family?
Language Preference *
Day Preference - 1st Choice *
Time Preference - 1st Choice *
Day Preference - 2nd Choice
Time Preference - 2nd Choice
Day Preference - 3rd Choice
Time Preference - 3rd Choice
Would you be willing to host a group in your home led by another leader? *
Additional Comments
(for example, which Group Leader you want, other members of the group, etc.)
Your answer
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