Name *

First Name

Last Name

Phone

(###)

###

####

Gender *

Male

Female

Date of Birth *

MM

DD

YYYY

Have you read the description of Summit Disciple Groups and group participant expectations? *

summitupstate.org/disciple

Yes

No

Have you already been invited to join a specific Summit Disciple Group? *

Yes

No

If yes, who invited you to participate in their group?

First Name

Last Name

Best Day(s) of the Week for Group Gatherings

Weekdays

Weekends

Both

Best Time of Day for Group Gatherings

Morning

Midday/Afternoon

Evening