Chalice Circle Online Registration Form

To find out more about Chalice Circles in general, click here.

The Chalice Circle registration deadline for Chalice Circles beginning in April 2010 is Sunday, March 14. However, newcomers to the church can sign up for Chalice Circles at any time.

Please provide the following contact information:

First Name

Last Name

Street Address

Address (continued)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

E-mail

Chalice Circles beginning in April 2010 will meet six times between April and June. Chalice Circles usually meet the first and third weeks of the month. Please select the times you are available to participate. Selecting more times will make it more likely for you to participate. Please do not sign up for Chalice Circles if you know already that you will not be able to attend most meetings.

            First preference:
            Second preference:
            Third preference:
            Fourth preference:
            Fifth preference:
            Sixth preference:
            Seventh preference:

Check any of the following that apply:

I am interested in being a Chalice Circle facilitator or assistant facilitator.
I am interested in hosting a Chalice Circle in my home.
I require childcare in order to participate.
If possible, I'd like to be in the same Chalice Circle as Winter 2010.
If possible, I'd like to be in a different Chalice Circle than Winter 2010.
If possible, I'd like to be in a Chalice Circle for men only.
If possible, I'd like to be in a Chalice Circle for women only.
I am interested in participating in an online Chalice Circle. (To participate in an online Chalice Circle, you must have a computer, a webcam, microphone, headphones, and a high speed internet connection.)

If you need childcare, what are the names and ages of the children for whom you need childcare:

Do you have any special needs regarding participating in a Chalice Circle or anything else that you would like us to know?

Please contact Reverend James Kubal-Komoto at minister@saltwaterchurch.org or at (253) 347-3346 if you have questions about registering for Chalice Circles.