Apply to become a Group Facilitator or Contact!

Please complete the form below to apply to become a group leader or contact!

Are you interested in helping out as a Group Facilitator or as a Contact? Note: Group Facilitators are also considered Contacts for their area
Facilitator Contact
Personal Information: Used for our records and to send you mailings, not given out to the public!
First Name:
Last Name:
Address Line One:
Address Line Two:
City:
State:
Country:
Postal Code:
Home Phone:
Work Phone:
Cell Phone:
Tell us a little about your journey and what you hope to be able to accomplish as a group facilitator or contact.

"Public" Information: This is the information we will provide to new straight spouses we refer to you ]! Note: If you would like new people to contact you by telephone please make a note in the comments field below along with the number at which they may contact you.
User Name: Can be your real name or a nickname.
Primary Email:
Alternate Email:
Group City: (If group leader)
State (or Province):
Any other comments or information you'd like to share: (Please note here any special information such as languages spoken other than english, specific contact issues such as best time to call etc.)

Miscellaneous Information:
If approved as a Group Facilitator or Contact, are you interested in having an email address at straightspouse.org to use for SSN business? If so, please check yes below and, upon approval, our webmaster will contact you to set up an email account for you.
Yes No We use the reCAPTCHA service to avoid spam please enter the two words shown in the field below.