EXIT71 LIFEGROUP REGISTRATION
First Name *
Last Name *
E-mail
Address *
State *	AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
City *
Phone number *
School *
What Grade are you in? *	6th 7th 8th 9th 10th 11th 12th
What is your age? *
What neighborhood do you live in? *
List 2 friends you would like to be in Lifegroups with: *
Upon receipt of your form, we will send you an email to let you know that we received your information. Lifegroups meet at 6pm beginning in room 2123. We will let you know what group you are in from there.