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.  This registration form includes an option for sign up for Tele-Connections.



Contact Information

  

  

  

Please Tell Us More

Your relationship to individual with BPD. I am the of the person with BPD.

Age of individual with BPD  

Your relationship to 2nd individual with BPD  I am the of the person with BPD.

Age of 2nd individual with BPD.  

Family Connections Preference: (optional)

  Please choose TeleConnections if none of the locations are applicable to you

Interest in teaching Family Connections and/or TeleConnections after finishing this course and receiving further training?

YesNoMaybe

We thank you for your registration - every family is important to us, and we know the burden this illness creates for your family. Please be assured that you will be offered the first possible opening in the class nearest you or in a TeleConnection or weekend class, according to your preference. We have a very limited staff and the growth of the program exceeds our ability for more personalized contact at this time. If you are unsure about whether this class is appropriate for you, please indicate so and the reason for this, below. Thank you.

Please enter the text in the grey box into the text field below.

captcha  

X

Forgot Password?

Join Us

Password Reset
Please enter your e-mail address. You will receive a new password via e-mail.