Connection Recovery Support Group Registration Form

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Connection Recovery Support Group Registration Form_2021

Connection Recovery Support group is for individuals who identify as having a mental illness and are 18 years and older.

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First Name *

Last Name *

Phone Number *

Email Address *

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

必填

First Name of your Emergency Contact *

Last Name of your Emergency Contact *

Phone Number of your Emergency Contact *

I confirm that I am over 18 years of age and identify as having a mental illness. *

Yes

Are you a Bernallilo County resident? *

Yes

Are you a Veteran? *

Yes

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