Action Group FacilitatorsPlease fill out the form below First Name* Last Name* Email* City of Group* If a virtual group, please write "Virtual" in the box.Cost per Month per Participant Group Start Date* MM slash DD slash YYYY Date of first group meeting.All Meeting Dates* Please list all scheduled meeting dates (click the "+" to add additional rows). Meeting Location* Participant Names and Contact Info*NameEmailPhone Number Please list all participants and their contact information.Are all covenants signed and returned* Yes No If no, who are you still waiting on to sign their covenant?? Please list all participants who have yet to sign their covenant.Any other details we should be aware of?Guides Names and Contact Info*NameEmailPhone NumberName of Business Please list all participants and their contact information.CAPTCHANameThis field is for validation purposes and should be left unchanged.
