small group registration form

Address: 

City:    State:    Zip Code: 

Home Phone:    When is the best time to reach you at home? 

Cell Phone:    May we contact you on your cell phone?  Yes  No

Work Phone:    May we contact you at work?  Yes  No

Email Address: 

I would like to register for:

  Message-based Small Group

  Fall GroupLink Event (October 3)

  Starting Point (Beginning September 12)

  Prime Time

How did you hear about CFC Small Groups:  PosterBulletinWebsiteOtherFriend     Age Group:  20-2930-3940-4950-6464+     Gender:  MaleFemale

I would prefer to meet on (please check all that apply): 
          Monday
          Tuesday
          Wednesday
          Thursday
          Friday
          Saturday
          Sunday

Time of day I would prefer to meet (please check all that apply): 
          Morning
          Mid-day
          Evening

Type of group I would prefer (please check all that apply): 
          Couples/Mixed Group
          Singles Group
          Men only
          Women only
          No preference         

Additional comments or questions (including information that would help in your small group placement):