Are you filling this form out for two people? Yes No

First Name:

Last Name:

Address:

City: State: Zip:

Birthday:

Phone Number:

E-Mail:

Select an Age Group: 18-23 24-35 36-45 46-60 60+

Marrital Status: Married Single Engaged

What type of MealGroup are you interested in joining? Couples Singles Same Gender Mixed No Preference

When are you available to meet? I/We can meet anytime.
If you have a preferred day to meet, please enter your choices below:
1st Choice: 2nd Choice: 3rd Choice:

I will be attending The Gallery Meal Group Launch on February 1st at Bethel Christian Fellowship? Yes No Unsure

Other members of your MealGroup: