Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you over 18 years of age? *

Yes

No

We will be hosting meetings monthly. What weekday evening would work best for you? We will gather votes and pick the best for the majority. *

Check all that apply.

Monday Evening

Tuesday Evening

Wednesday Evening

Thursday Evening