CLAPHAM CIRCLES

Thank you for your interest in joining a Clapham Circle!

Primary Contact

First Name

Last Name

Additional Adult (if applicable)

First Name

Last Name

Email Address

Primary Contact Email. This is the email address where all Clapham Circle details will be sent.

Phone

Primary Contact

(###)

###

####

Your Day Choice

Please select your preference. Clapham Circles will meet once a month for three months on the first Wednesday or the second Sunday of the month.

WEDNESDAY DINNER (First Wednesdays @ 6:00-7:30 PM - February 7, March 6, April 3)

SUNDAY LUNCH (Second Sundays @ 1:00-2:30 PM - February 11, March 10, April 14)

Are You Willing to Host?

Your Location

Please indicate what part of town you live in so we can try to place you with a group in close proximity.

Greensboro

High Point

Winston Salem

Kernersville

Other (Please indicate in Notes field below.)

Please Select Your Preference for Adults Only or Adults & Children

Total Number of People in Your Family to Attend Clapham Circle

Children to Attend Clapham Circle (list names/ages)

Notes (list any food allergies, other needs, or questions)