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Resources & Empowerment Group Registration
Complete this form and a staff member will contact you with the address and/or virtual meeting information to complete your registration.
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Group Member Name
Your answer
Group Member Phone Number
Your answer
Group Member Email Address (Please use the email that you get alerts from)
Your answer
Would you like to attend in person (we are located in St Pete near to the Central Ave bus station) or via Zoom?
In person
Online
I need one time case management assistance (Please book your free consult on our website via our Bookings page)
Clear selection
What city and state are you in? We provide resources for all areas but, the majority of our resources are based in Pinellas County.
Your answer
What resources are you most interested in at this time?
Therapy
Youth Resources
Childcare
Housing/Financial Assistance
Employment
Entrepreneurial Resources
Yes
No
Therapy
Youth Resources
Childcare
Housing/Financial Assistance
Employment
Entrepreneurial Resources
Yes
No
Do you have children under the age of 18?
Yes
No
Clear selection
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