First Name

Last Name

Date of Birth

Email Address

Phone Number

Preferred method of contact

HOST an in-person group (Y/N)

HOST a Zoom group (Y/N)

Lead and teach an in-person group (Y/N)

Lead and teach a Zoom group (Y/N)

Lead an in-person group video study (Y/N)

Lead a Zoom group video study (Y/N)

Lead a social media group

What social media platform do you prefer?

Topics of study you would like to cover

Desired age group

People with or without kids?

All male or all female group?

Days of the week, times, etc. that you are available