October 23, 2014

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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)

First Name*
Last Name*
Your Email*
Phone*
City*
State*
Zip Code*

Please Tell Us More

How did you hear about this class?*
Your relationship to individual with BPD*
Other
Age of individual with BPD*
Please Describe Your Situation*
Family Connections Preference: Please choose TeleConnections if none of the locations are applicable to you
Family Connections Locations (in-person) or, TeleConnections (telephone)
Interest in teaching Family Connections and/or TeleConnections after finishing this course and receiving further training?
 Yes No
Why?
Please enter the text in the grey box into the text field on the right.
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