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JOIN G12 LIFE GROUPS

Please complete the following:

(Note: Fields marked with an asterisk are required.)

FIRST NAME:	*
LAST NAME:	*
ADDRESS:	*

CITY:	*
STATE:	*
ZIP:	*

PREFERRED LOCATION OF THE LIFE GROUP:
PREFERRED DAY OF THE WEEK :
PREFERRED TIME OF DAY :

HOME PHONE:	*
WORK PHONE:
CELL PHONE:
EMAIL:	*

GENDER:	MALE FEMALE *
DATE OF BIRTH:
MARITAL STATUS:
CHILDREN & AGES:
DESIRE TO BE A LIFE GROUP COACH:	Life Coach Requirements