"Learning to Live, Learning to Love" Phase I Course Interest

Course Interest

In which course would your friend/relative/organization be interested?
Which Maryland class location(s)?

Silver SpringBaltimore (Towson area)Other
Which class?

Women's ClassMen's ClassYouth/Teen
Any additional comments or questions?

Please enter information about your relative.
Relative's Name*
First Name only
Relationship to you*
Person's Email
example@example.com
Person's Phone Number
Please enter a valid phone number.
Is this a mobile phone?

YesNo
When we reach out to them, will it be their first time hearing about our program?

Yes. I have never mentioned it to them.No. I have mentioned it to them once or twice.No. I have talked to them about it extensively!

Please enter information about the person (non-relative).
Person's Name*
First name only
Association with you*
Person's Email
example@example.com
Person's Phone Number
Please enter a valid phone number.
Is this a mobile phone?

YesNo
When we reach out to them, will it be their first time hearing about our program?

Yes. I have never mentioned it to them.No. I have mentioned it to them once or twice.No. I have talked to them about it extensively!

Please enter information about the group or organization.
Organization/Group Name*
Organization Type*
Your relationship to this organization*
Member, leader, supervisor, etc.
Do you have authority to make decisions to for this group/organization.

Yes, I do not need another person's approval.Yes, but I need approval from another person.No
Please enter the contact information for any person we should contact besides you.
Name of Organization/Group Contact Person*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.

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