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Please note that you do not have to release all information if you do not want to; however, we need at least one form of identification (first or last name) and one form of contact (email or phone number) .

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* 1. Name

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* 3. Phone

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* 4. Preferred form of contact?

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* 5. What days work best for you to attend meetings ?

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* 6. What times work best for you to attend meetings ?

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* 7. Would you like group facilitators to reach out to you to answer any questions and provide you with additional information?

Please keep in mind that communications via the internet are not secure. If you would prefer to share your name and contact information more securely, please call Tsion Meles at 520-202-1775.

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