Wednesday, 10 March 2010

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Register Your Group

Please fill in the information that is applicable as of now. If some details are currently undecided, just leave blank. WE DON’T POST THIS INFORMATION. We realize you may be in the preliminary stages of your plans. By submitting this registration form, you open the door to receive help from our Avenue Chapter Support Team. They will contact you by email to give you access to our TLC- Teleconference Leader Coaching, and you can ask questions via email. When ready, you’ll submit your listing for the AVENUE NATIONAL CHAPTER DIRECTORY.

New Chapter Contact Information
City
State
 Zipcode

AVENUE Operation Destiny for Men

Are you offering this group?       Yes No   Anticipated Start Date:
Are you leading this group?       Yes No   Total # Leaders:
Chapter Contact Information
Your Name:   Home Phone:
Your Email:   Cell Phone :
Alt. Email :   Work Phone : (opt)

AVENUE Healing Choice for Women

Are you offering this group?    Yes No   Anticipated Start Date:
Are you leading this group?    Yes No Total # facilators:
Chapter Contact Information
Your Name: Home Phone:
Your Email:   Cell Phone :
Alt. Email :   Work Phone : (opt)

Chapter Affiliation

If a church, counseling or recovery center is initiating your chapter formation, please include their name, address, and other contact information that might be known. (Optional)
Confirmation Contact Information
Please supply the name and email of the person to receive the confirmation email for this group registration.
Address Confirmation to :
Email Address to send to:
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