Study Group Request Form

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STUDY GROUP REQUEST FORM - Online

PLEASE COMPLETE AND SUBMIT A SEPARATE REQUEST FORM FOR EACH STUDY GROUP
Remember - All spaces must be filled in!! DON'T FORGET THE "SEND FORM" BUTTON AT THE BOTTOM.

Is this an Open Study Group or a Pending Study Group?

Today's Date

Study Group Title

Study Group Number

Meeting Day and Week

Meeting Time

Your Name (last name first)

Preferred Telephone

Other Telephone

Address: Street

Address: City

Address: Zip code

Email address

repeat Email address (for accuracy)

Comments and suggestions

Please check the information above carefully for accuracy

For further information email Rosemary Rubin at: rrubin@socal.rr.com

Study Group Request Form - Online

Brandeis National Committee - San Fernando Valley Chapter

STUDY GROUP REQUEST FORM - Online