CCC Groups & Classes Bio Form

Who will be leading this class? *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Start Date: *

MM

DD

YYYY

End Date:

MM

DD

YYYY

Start Time: *

Hour

Minute

Second

AM PM

End Time: *

Hour

Minute

Second

AM PM

Where will you be meeting?

Off Campus (not in a home)

In a home

Room 2

Room 4

Room 6

Room 11

Room 12

Other

I'm not sure, I would like help with finding a meeting place.