Are you... *

currently in a Community Group?

not currently in a Community Group?

Name *

First Name

Last Name

Is your spouse joining a group with you?

Check only if it applies to you.

Yes

No

Do you have children in Lighthouse Journey or CSM? *

Yes

No

If you would prefer an online group (Zoom/Google Hangout) due to COVID, check this box.

I would currently prefer an online group.

Phone *

(###)

###

####

May we text you? *

Yes

No