*First Name:
*Last Name:
*Contact Phone:
Second Contact Phone:
Email:
*Best Time To Reach:	Mornings Evenings Anytime Weekends
*My life group is best described as a:	Select One Fellowship Group Discipleship Group Outreach Group Interest-Based Group
*Describe Your Life Group Idea:
*Proposed Meeting Days:	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Life Group Assistant:
*Potential Location(s):
*Describe the Goals of this Life Group: