APPLICATION FOR A GROUP SESSION

To make application to join one of our Group Sessions, please complete and submit this form.

Which Group Session would you like to participate in?

Anger Management
Concerned Persons Group
Conquering Chemical Dependency
Restoring Families
Stepping Into Freedom
I'm not sure - I'd like to know more.

Would you like to add a comment regarding this or another matter?

Other:

Enter your comments in the space provided below:

Tell us how to get in touch with you:

Name
E-mail
Tel
FAX
Please contact me as soon as possible regarding this matter.

PCCUAD Group Session Application Form.
Copyright © 2001 [Powell County Ministerial Association]. All rights reserved.
Revised: 07/20/06.