Name Phone
E-mail Address
married/empty next divorced/single again retired other
Your hobbies/interests
What day/time of the week is best for you to meet?
What is most important to you when choosing a Home Community?
Location very important somewhat important not important
Life-Stage very important somewhat important not important
Affinity (things in common) very important somewhat important not important
Please indicate your approximate location on the map below.
Watauga County section 1 section 2 section 3 section 4 section 5 section 6 section 7
Ashe County Avery County Wilkes County Caldwell County Tennessee
Would you be willing to host a Home Community? yes no
Would you be willing to lead a Home Community? yes no
