Family Connections Registration Form

Family Connections is a 12-week program for relatives with a loved one with borderline personality disorder. For full information, go to the Family Connections section on the Home Page. For registration,  complete form below.  Please note there is not a program in every location in the country and so you perhaps might want to consider Tele-Connections which is the course conducted via weekly conference calls.  Registration form includes the option for sign up for Tele-Connections

Contact Information (*Indicates required fields)

Your Name*

Your Email*

Phone*

City*

State*

Zip Code*

Please Tell Us More

How did you hear about this class?

Choose your Family Connections class location from the drop down menu. If no class is currently in your area, or if you prefer, choose "TeleConnections" class:

---CanadaWashington, DCVirginaGeorgiaWestchester County, NYNew JerseyOhioTexasNew YorkLos AngelesPasadenaTeleConnection

How are you related to your affected relative? "I am their..."

 Parent Sibling Spouse Adult Child

Other

How old is your affected relative?

Please briefly describe your situation with your BPD loved one.

Are you interested in teaching the Family Connections course in the future?

 Yes No

Please enter the text in the grey box into the text field on the right.