Grace Community Church

Community Group Registration

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Name


First Name	Last Name

Address


Address

Address Line 2

City	State	Zip Code

Phone

Phone Number

Email Address

Days of the week you are available

Select all that apply

Earliest start time on weeknights:

I am willing to travel up to ________ miles to attend at another's home.

Age Group: (20's, 30's, etc.)

If you have children which may need to accompany you, how many and what age

Tell us your interests:

Select all that apply

Yes! I am interested in joining a Grace Community Group.
Yes! I am willing to host a group in my home.
I am interested in becoming a group facilitator/leader. (Training will be provided)
I would like to be contacted for additional information.

* required