I-F Club General Interest Form

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I-F Club LLC
Communication Therapy and Social Groups
13303 NE 175th St. Suite A (upstairs)
Woodinville, WA 98072

Please fill out the form as best you can for the potential new member, and we will be in contact with you regarding follow up information.

Filling out this form will include you in our mailing list for more information, open houses, and other events, but does not require a commitment to join any groups or services.

Email *

First Name *

The name of the person who would be participating

Last Name *

Preferred Name(s)

Please list any preferred names/pronouns

Phone number

Birthdate *

YYYY

How do you prefer to be contacted?

Phone Call

Text

Video Chat

Other:

I am filling this form out

for myself

for someone else

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