*1.Your Name(Required.)

*2.How would you like to be plugged in? (Select all that apply)(Required.)

Attending

Hosting in your Home

Leading Discussion

*3.What city do you live in?(Required.)

Wilton

Ridgefield

Weston

Norwalk

Fairfield

New Canaan

Trumbull

Westport

Redding

Stamford

Other (please specify)

4.What day(s) work better for you?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

5.Do you prefer to be in a Group with Parents of younger children? (If possible, based on interest )

Yes

No

No preference

*6.Email Address(Required.)