Group Leader Gathering

Name*
First Last
Email*
Phone*
Please indicate by checking one of the follow boxes:*
- I am a current leader/facilitator
- I am a former leader/facilitator and interested returning to leadership within Grouplife
- I was invited by my group leader and I am interested in Grouplife leadership
- I was invited by my group leader and I am not really interested in Grouplife leadership
Will there be any other adults attending with you?*
(i.e. Spouse)
- Yes
- No
Please list any adults attending with you:*
Name (First, Last) Phone Email
(2) Please indicate by checking one of the follow boxes:*
- I am a current leader/facilitator
- I am a former leader/facilitator and interested returning to leadership within Grouplife
- I was invited by my group leader and I am interested in Grouplife leadership
- I was invited by my group leader and I am not really interested in Grouplife leadership
Do you need childcare?*
- Yes
- No
Please list names and ages for each child:*
Allergies
Please let us know if your child has allergies.
Name
This field is for validation purposes and should be left unchanged.

Name (First, Last)	Phone	Email