Connection Recovery Support Group Registration Form
Connection Recovery Support group is for individuals who identify as having a mental illness and are 18 years and older.
* Required
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
I would like to attend the following meeting(s). Please check all that apply.
*
Meetings are currently being held from 6:30-8:00 pm via Zoom. You must be on time to be admitted into the meeting. Rooms open at 6pm for technical support and socialization. The meeting starts promptly at 6:30.
Monday
Wednesday
Friday
Required
First and Last Name of your Emergency Contact
*
Your answer
Phone Number of your Emergency Contact
*
Your answer
Are you a Bernallilo County resident?
*
Yes
No
Are you a Veteran?
*
Yes
No
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
