2Be1 - A Singles Program
Initial Submission Form
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Email *
How did you hear about the 2Be1 Program? *
Date of event you wish to participate? *
Full Name *
Date of Birth *
City & State *
Phone Number *
Single Status *
Required
Do you believe in monogamy? *
Required
Do you believe in marriage? *
Required

Code of Conduct 

Summary of Services:

The Couples & Family of MPB Group, Inc. is pleased to offer the 2 Become 1 (2Be1) Program, which is a Singles Program that wishes to guide and facilitate unattached and fully available singles towards a meaningful monogamous relationship that leads to an everlasting marriage. 


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Required

Respect

All participants will be respectful

Respectful of other values and beliefs

Listen to others without interrupting

Accept other’s point of view as a growing opportunity

No escalations

No outbursts, lashing out, escalated tone, and physical altercations

Goal is to provide a safe environment in order to share ideas 

Understand and agree that when someone says “no” to respect their boundaries

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Required

Attendance

All Participants will be present for meetings

Participants  will show up on time to scheduled meetings and events

Limit distractions so that you are fully present

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Required

Protection of Company Property 

All Participants will treat the company property with care and respect

Technology, furniture, and any other equipment owned by MPB Group Inc. will be handled with care

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Required

Communication

All Participants will allow space for each person to share without interruptions

Participants  will be open and honest with themselves and others in the context of group meetings

Participants  will alert MPB staff of any issues as they arise 

Any concerns about negative interactions or communications with another participant should be shared with one of the MPB staff 

Confidentiality will be respected regarding the concerns 

Participants  will be mindful of how long they share to provide others a chance to speak

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Required

Disciplinary Action

Our company has the right to take disciplinary actions against Participants  who do not uphold the code of conduct and will not be invited back to participate.

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Required

I agree to the rules outlined in the Code of Conduct above. I release MPB Group Inc. to take appropriate action, including being removed from the group, if they see fit based on violation of this agreement.

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Required

Informed Consent

Benefits

This program may provide helpful interventions that may improve relationships and/or resolve specific issues through discussions.

This program may be helpful in creating a sense of connection and community by meeting other singles.

This program may provide helpful interventions that may improve insight into your own attachment needs and your sense of self within a relationship.

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Required

Informed Consent

Risks

Growth and connections cannot be guaranteed.

This process may bring about unpleasant memories, feelings, and/or sensations of guilt, anxiety, anger, and sadness.

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Required

Informed Consent

Confidentiality

What is discussed during private sessions during the event is kept confidential. No content of the sessions, whether verbal or written may be shared with another party without written or verbal consent. The following is a list of exceptions: 

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Required

Informed Consent

Limitations of Confidentiality

Duty to Warn and Protect

The staff is required to warn a potential victim if a participant is threatening serious injury to someone.

The staff may be required to hospitalize the participant and/or contact family members if the participant threatens to harm him/herself.

Abuse of Children and Vulnerable Adults

The staff is required by law to report if a child, an elderly person, or a disabled person is being abused. The staff is also required to report past instances of child abuse when specific information about the abuser is available

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Required

Informed Consent

Communication

MPB Group will post meeting dates on their website – mpbhealth.com under the Couples & Family Institute Program. You may email cfi@mpbgroupinc.com directly for questions and concerns.

Privacy Expectations - it is expected that no filming, recording, photos, and other social media platforms will be allowed during the program.

We respectfully ask that you leave your cell phone safely in your car.

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Required

Informed Consent

Payment

Payment for attendance for 2Be1 events are as follows and must be paid prior to attendance date:

$45.00 per meeting for the Singles Meetings (meets on the last Thursday of each month)

Save $10 by bringing a friend who is unattached and fully available

Your friend pays the full amount of $45.00

$95.00 per meeting for the Couples Meetings (meets once per quarter, the 2nd Thursday of the month)

Please go to https://www.mpbhealth.com/services/couples-family-institute/ to pay fee by clicking PayPal icon

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Required

Informed Consent

Consent for Participation and Acknowledgement

I hereby attest to reading this document and understand its contents.

I authorize payment directly to the MPB Group, Inc.

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Required

Informed Consent

Acknowledgement of Receipt of the Notice of Privacy Practices: By signing below, I understand that I have the right to revoke this consent, in writing, except where we have already made disclosure in trust on your prior consent. Your signature certifies that you have read, understand and agree to the terms stated in this Consent for Treatment Form.

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Required
I have read, understood and accepted the Mission Statement of 2Be1, Code of Conduct, Informed Consent and Payment Requirements

After submission of this form, proceed to PayPal link for payment.
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Required
A copy of your responses will be emailed to the address you provided.
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