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AC Groups - Organization Application Form

Questions marked with a * are required

1.First Name

2.Last Name

3.Phone Number

4.Email Address

5.Organization Name

6.Location (city, state)

7.Occupation

8.Are you in a leadership position?

Yes

9.Gender

Female

Male

Non-binary

Other

10.Why do you think Authentic Connections Groups might benefit you and/or your organization?

11.Time Zone

Eastern Time

Central Time

Mountain Time

Pacific Time

Other

12.Please check all times you are available or that may work (assuming a few weeks' notice) to attend weekly, one-hour groups:

13.Is there anything else that you would like us to know?