Please fill out as much information as you can. Fields marked with an * are required before submitting this form. The information provided here is subject to verification. Group changes will appear as soon as possible online and in the next edition of the printed directory.

Your Information
Your Name*
Your Email*
Group Information
Group Name*
New Group?


Homegroup Members
Founding Date
Election Month
Meeting Information
Day
Time
Location Name
Address
City
Zip Code
Meeting Type
Open / Closed




Wheelchair Accessiblity



Additional Information








Secretary
Name
Address
City
Zip Code
Primary Phone
Alternate Phone
Email
Mailing   (If different from secretary info above)
Name
Address
City
Zip Code
Primary Phone
Alternate Phone
Email
Treasurer
Name
Address
City
Zip Code
Primary Phone
Alternate Phone
Email
Intergroup Rep
Name
Address
City
Zip Code
Primary Phone
Alternate Phone
Email
Alternate Rep
Name
Address
City
Zip Code
Primary Phone
Alternate Phone
Email