Membership Survey

If you are interested in becoming a member, please complete this brief survey. 

Please complete as soon as possible.  Further information will be forthcoming.  Thanks for your time - Hope to see you at the meetings - Spread the news to your friends.  Thanks, MK & ML

NOTE: All group correspondence will be through e-mail.   If you do not have access to e-mail, please supply either an address or phone number in the appropriate section below. 

Name:
(First Name, Last Initial)
Significant Other Name:
(First Name, Last Initial)
Email Address:
Address:
(Include City, State & Zip)
See NOTE above.
Phone Number:
See NOTE above
Check all that interest you: Support discussions
Speakers
Game night
Dances
Camping
Poetry night
Skills and talent sharing
Community service projects
Pot luck dinners
Other interests:
Comments or suggestions:

form creator