Support Group & Workshop Registration
Please complete this form to register for a current support group or workshop, or to be notified for upcoming ones.
Email address *
What is today's Date? *
MM
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DD
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YYYY
What is your name? *
Your answer
What is the best email to reach you at? *
Your answer
What is your Zip Code? *
Your answer
What is your street address or PO Box?
Your answer
What is your state?
Your answer
What is your city?
Your answer
What is your best phone number to contact you with?
Your answer
My Gender is *
I am: *
How did you hear about Hope Recovery? *
I agree, I did read the Group Agreement and Guidelines above. *
I agree to keep all group members and information that could impact another member confidential *
Required
List of workshops currently accepting registrations **Workshops are the same content each time offered and you do not need to repeat them in future months**
Please register me to the following group(s). I understand I will be contacted within 24-48 hours after my registration is received.
Please add me to the following group list(s) as I would like to register for the group(s) when they become available.
Here is a bit of information about myself in relationship to the group I'm registering for or asking to be added to. *
Your answer
I have the following questions or comments:
Your answer
You will be contacted within 24-48 hours of submission of your registration.
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