[d]Groups Interest Form • Southern Hills

First Name *

Last Name *

Mobile Number *

Email Address *

Gender

Marital Status

Spouse name (if applicable)

Spouse Mobile Number

Spouse email

Please select which you would like:

I am interested in leading a [d]Group

My spouse and I are interested in co-leading a couples [d]Group

I am interested in joining a [d]Group with 3 to 4 other people

My spouse and I are interested in joining separate, gender specific [d]Groups with 3 to 4 other people

My spouse and I are interested in joining a [d]Group with up to 6 other couples

Select your availability below:

If you and your spouse would like to be in separate groups, please indicate their availability:

If you have children at home, please list their names and ages:

Provide any additional information that would be helpful to us in connecting to a [d]Group: