100%

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? 
9.Gender
10.Relationship Status
11.If you are a parent, please indicate the age range(s) of your child(ren)
12.Why do you think Authentic Connections Groups might benefit you and/or your organization?
13.Please check all times you are available or that may work (assuming a few weeks' notice) to attend weekly, one-hour groups:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
5:00 PM
6:00 PM
7:00 PM
14.Is there anything else that you would like us to know?
Powered by QuestionPro