Wise Aging Group Application
First Name
Last Name
Preferred Pronouns
Please select...
She/her/hers
He/him/his
They/them/theirs
Ze/hir/hirs
Email Address
Preferred Phone Number
Back Up Phone Number
Your Age
Would either meeting in person or meeting by Zoom limit your joining the group?
I am comfortable with meeting in person.
I can only join the group if we have a Zoom option.
Tell us why you would like to participate in a Wise Aging Group:
Please let us know if there are any diversity considerations about yourself that you wish to have taken into account.
Is there anything about your current situation that you think we should know (e.g., upcoming travel, medical considerations, other current challenges)?
Contact Information