Thank you for taking time out of your busy schedule to register for One Month To Live Group Challenge. Please fill out the form below.

* Will you be participating in the One Month To Live Small Group Challenge?	NO YES
* Would you like to be a facilitator of a small group?	NO YES
* Full Name
* Address
* City
* State
* Zip Code
* Phone (Home)
* Phone (Cell)
* Email
* Are you a member of West Point?	NO YES
Please select the group you would like to participate in:
Men All Ages	Men All Ages
Men 50+	Men 50+
Men 26-40 Something	Men 26-40 Something
Men 18-25	Men 18-25
Women All Ages	Women All Ages
Women 50+	Women 50+
Women 26-40 Something	Women 26-40 Something
Women 18-25	Women 18-25
Married Couples	Married Couples
Singles Mixed	Singles Mixed
Single Men	Single Men
Single Women	Single Women
College	College
* Will your child/children attend One Month To Live for students?	NO YES
If yes, which grade(s):	Preschool 1-3 4-5 6-8 9-12
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