Moai Interest Form - Smartsheet.com

Moai Interest Form

To join a Moai group for walking, potluck, dining or purpose discussions, please complete this form and the program coordinator will contact you to discuss details and get started!

For a full list of groups to reference while completing this form, please view the Moai Group List: www.bchd.org/docs/healthy-communities/MoaiList2018.pdf

First Name*

Last Name*

Email Address*

Phone Number*

Zip Code

Walking Moai Groups

Are you interested in participating in a Walking Moai?*

Yes No Not now

Primary Interest

Secondary Interest

Interest in New Walking Groups with Themes

"Doggie Play Date" - dog-friendly walking and socializing Fun Run - flexible pace with conversation as priority "Photo Safari" - walking and photography "Laugh Yoga" - social group to laugh and stretch

Comments

Potluck Moai Groups & Restaurant Dining Moai Groups

Are you interested in joining a Potluck or Restaurant Dining Moai?*

Yes No Not now

Primary Interest

Secondary Interest

Comments

Purpose Discussion Moai Groups

Are you interested in joining a Purpose Moai?*

Yes No Not now

Comments

Additional Notes for the Coordinator:

Thank you for your interest!
The information you are providing will be shared with the program coordinator who will assist you with group matching and introductions. Please wait until you receive confirmation before you attend a group meet up.

If you have any additional questions, contact Tiana
Rideout at tiana.rideout@bchd.org or 310-374-3426, ext. 139.

Send me a copy of my responses

Email address

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