Discussion Group Application

Print this out, fill it in and bring it to class, or paste it into an email and send it to Stacy at keogh@unm.edu.

Name:

Gender:

Phone numbers:

Email:

Would you like to be a convener?  Yes________  No________

Do you prefer an all-woman group? Yes_______

Please indicate times you COULD BE available for discussion group meetings (one hour sessions), as well as which times are best for you.

             Mon     Tues     Wed     Thurs      Fri     Sat     Sun
8am

9am

10am

11am

12pm

1pm

2pm

3pm

4pm

5pm

Evening

Best times: