Be My Witness Small Group SignUp

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

I would like to be a:

FacilitatorCo-FacilitatorParticipantEither

Where would you like to attend a small group session? (check all that could apply)*

Available days/times (select all that work for you):

Tuesday Afternoon - EnglishWednesday Morning - EnglishThursday Evening - EnglishThursday Evening 7PM HSH - SpanishSunday Evening 5:30P Teen Ctr - YOUTH GROUP

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is there a Small Group Facilitator or are there other Small Group Participants, whose group you would like to be a part of? If so, please list names:

List any concerns, comments, questions, or constraints you may have: