Cancellation Request Please enable JavaScript in your browser to complete this form. Name of Member * First Last Email of Member * Who is your group leader? * First Last I am cancelling my membership because: *I don't feel like I need it anymoreI have found a local groupI can't afford itI don't find it helpfulI had problems with the leaderI had problems with other group membersIt doesn't fit my scheduleOther (please specify in the comments box below) Please share why you are cancelling, in your own words. All feedback is welcomed. I’m very satisfied with my Small Groups Online experience. * Agree Disagree Neutral Not Applicable I’m very satisfied with my Small Groups Online experience. Agree I’m very satisfied with my Small Groups Online experience. Disagree I’m very satisfied with my Small Groups Online experience. Neutral I’m very satisfied with my Small Groups Online experience. Not Applicable I’m very satisfied with my Small Groups Online leader. * Agree Disagree Neutral Not Applicable I’m very satisfied with my Small Groups Online experience. Agree I’m very satisfied with my Small Groups Online experience. Disagree I’m very satisfied with my Small Groups Online experience. Neutral I’m very satisfied with my Small Groups Online experience. Not Applicable I believe my Small Groups Online experience experience has given me greater clarity as it pertains to my or my husband’s unhealthy choices and a better understanding as to why I am tempted to do the things I do. * Agree Disagree Neutral Not Applicable I’m very satisfied with my Small Groups Online experience. Agree I’m very satisfied with my Small Groups Online experience. Disagree I’m very satisfied with my Small Groups Online experience. Neutral I’m very satisfied with my Small Groups Online experience. Not Applicable I believe my Small Groups Online experience experience has better equipped me to handle things when I feel tempted to act out sexually and/or feel the need to lash out at my husband for his choices. * Agree Disagree Neutral Not Applicable I’m very satisfied with my Small Groups Online experience. Agree I’m very satisfied with my Small Groups Online experience. Disagree I’m very satisfied with my Small Groups Online experience. Neutral I’m very satisfied with my Small Groups Online experience. Not Applicable I believe my Small Groups Online experience has helped me find healing and peace. * Agree Disagree Neutral Not Applicable I’m very satisfied with my Small Groups Online experience. Agree I’m very satisfied with my Small Groups Online experience. Disagree I’m very satisfied with my Small Groups Online experience. Neutral I’m very satisfied with my Small Groups Online experience. Not Applicable Name Submit
