Name:

i AM A TUPC member?   c

 c  Yes

 c  No

Address

City / Zip:

Phone (Day):

Phone (Evening):

Best Time to Call:

Email:

Are You Currently a member of an active small group at TUPC?

 c

 Yes

c

  No

Preferred Meeting Day:

c  Mon

c

 Tues

 c  Wed

c  Thurs

 c  Fri

 c

 Sat

c

  Sun

Preferred Meeting Time:

c

  Morning

c

  Afternoon

c

  Evening

Are you willing to  Host a Group  c

c

 I Need Childcare

Would you prefer to join a group with other newcomers or an existing group at TUPC (By proximity to home?)

 c   Newcomers

 c   Close to Home