Group Registration

IC Purvis & Ahles Group

Women Only
Thursday @ 6:30 PM
Imlay City

Leaders:

Dianne Ahles
Carol Purvis

Please complete the form below to register for IC Purvis & Ahles Group.

First Name

Last Name

Home Phone

Mobile Phone

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Email

Address

Spouse First Name

Spouse Last Name

Spouse Mobile Phone

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Spouse Email

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