New Customer Registration Form

Full Name*

First NameLast Name

Date of Birth*

Date

E-mail*

example@example.com

Phone Number*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Parish*

Are you already in a men's group?*

YesNo

Are you the leader / facilitator of your men's group?*

YesNo

If not, who is your men's group leader / facilitator?*

	First Name	Last Name	Email Address	Phone Number
Men's Group Leader

Is your men's group open to additional members?*

YesNo

Who is in your men's group?*

	First Name	Last Name	Email Address	Phone Number
1
2
3
4
5
6
7
8

What day of the week does your men's group meet?*

What time does your group meet?*

Hour Minutes

AM/PM Option

How often do you meet?*

WeeklyEvery 2 WeeksMonthly

What's working well with your men's group? What do you think could work better?*

Is there anything else you'd like us to know about your men's group or ways we could support you?*

Have you been in a men's group before?*

YesNo

You are interested in:*

Joining an existing group but don't want to facilitate one.Starting and facilitating a new men's group.

Check all the days of the week that work for you to meet:*

Check all the times of day that work for you to meet:*

MorningAfternoonEvening

What do you hope to give / get from this group? Rank level of importance to you.*

	Vital	Important	Less Important
Camaraderie and Fellowship
Spiritual Growth
Developing a relationship with other Catholic men
Ability to meet others who can hold me accountable
Learn more about my faith
Become a better man and/or husband and/or father
Develop self-discipline in my spiritual life

We want to hear from you, what are some of your expectations, questions, and/or concerns when considering joining? What else do you want us to know about you?*

Men's Group Registration Form