Registration

Westside Church – Omaha

Starting Date:

October 16, Wednesdays @ 1:00 – 3:00 p.m.

Facilitator:

Alice Teachout

Modality:

In Person

Location:

Westside Church, 15050 W Dodge Rd, Omaha, NE 68154

Language:

English

Available Spots:

First Name*

Enter your First Name

Last Name*

Enter your Last Name

Birthdate*

Email Address*

Phone Number*

Line Type*

Mobile

Landline

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long were you married?*

How long have you been a widow?*

Husband's first name and date of death*

Preferred Language*

English

Spanish

Other

Preferred Method of Communication*

Text

Phone Call

Facebook Messenger

What activities do you enjoy doing?*

Activities, hobbies, etc.

What are your expectations of this group?*

What does your immediate family look like?

Children, grandchildren, siblings, etc.

How did you hear about this group?*

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