Life Story Club Member Profile
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Email *
Please fill out this Member Profile sheet so we can help place you into a Club that is right for you! New participants will receive a welcome email/call from our Club facilitator.
Participant First Name: *
Participant Last Name: *
Participant Preferred Pronouns
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Participant Contact Info
Participant Phone Number: *
Participant Address
Street *
City *
State *
Zipcode *
Participant Date of Birth: *
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Participant Language Preference
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What aspects of the Life Story Club program appeal to you? (select all that apply)
Are you interested in a club that meets virtually or in-person
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Which of these topics interest you? Select all that apply!
We can't wait to meet you! Please describe yourself in a few sentences?
If you're interested in capturing/saving a story, is there a particular story you're hoping to save? Who is it for?
How did you hear about Life Story Club?
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