Registration Form

To inquire about the program or how you might best fit in contact Alisa Gould Sugden.

To register please send the following information pasted into an email message:

Chalice Circles Registration Form

Please Print clearly

Name: __________________________________________

Address: ________________________________________

City and Zip: _____________________________________

Phone #'s: _______________________________________

Email Address: ___________________________________

I will need childcare to participate in a circle.    Yes     No

Age of child or children: _________________________

I have the following special needs that may affect my participation
(for example, pet allergies or access issues).