Name *

First Name

Last Name

Phone

(###)

###

####

Commitment *

These sessions meet twice a month at minimum, are you willing to commit to at least one month at a time?

Yes

I am willing to make this commitment, but I would like more information before I make a final decision.

Day of the week availability *

When can you meet?

Wednesday

Thursday

Either

Time of day availability *

What time can you meet?

Morning

Afternoon

Either