Group Leader Gathering Date: July 16, 2016 Time: 9a – 2p Location: Commonwealth Chapel, 3505 Old Hundred Road S., Midlothian, VA 23112 Registration: Group Leader Gathering Name* First Last Email* Phone*Please indicate by checking one of the follow boxes:*I am a current leader/facilitatorI am a former leader/facilitator and interested returning to leadership within GrouplifeI was invited by my group leader and I am interested in Grouplife leadershipI was invited by my group leader and I am not really interested in Grouplife leadershipWill there be any other adults attending with you?*(i.e. Spouse)YesNoPlease list any adults attending with you:*Name (First, Last)PhoneEmail (2) Please indicate by checking one of the follow boxes:*I am a current leader/facilitatorI am a former leader/facilitator and interested returning to leadership within GrouplifeI was invited by my group leader and I am interested in Grouplife leadershipI was invited by my group leader and I am not really interested in Grouplife leadershipDo you need childcare?*YesNoPlease list names and ages for each child:*AllergiesPlease let us know if your child has allergies.CommentsThis field is for validation purposes and should be left unchanged.