Wednesday Support Group Registration

Wednesday Support Group RegistrationTeam Access2026-03-31T00:02:21+00:00

You are registering for the Wednesday Support Group. Complete the form below to receive your Zoom link.

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Contact Details

Name*

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Email*

Enter Email Confirm Email

Is this your first session since April 1?*

Yes

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Phone Number*

Emergency Contact Name*

Emergency Contact Phone Number*

City/Region*

How did you hear about our support group?

If you selected 'other,' where did you hear about our support group?*

Do you have any specific triggering topics you would like to avoid or would want a warning before discussing?

Do you have specific personal goals you would like to accomplish in this group? If so, what are they?

Do you have anything specific you would like to discuss this week?

Is there anything else you think we should know?

All support group attendees will get our newsletter with additional resources. If you do NOT want these additional resources, please opt out by typing 'OPT OUT' below.

Please review our Code of Conduct and Liability Waiver before submitting your registration.

Click here to view our Code of Conduct and Liability Waiver.

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