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?

Prefer Family Connections (in-person) or, TeleConnections (telephone)

---CanadaWashington, DCVirginaGeorgiaWestchester County, NYNew JerseyOhioTexasNew YorkLos AngelesPasadenaLA South BayOrange CountySan Fernando ValleyInland EmpireCentral CoastSan Francisco BayTeleConnection

Your relationship to individual with BPD

 Parent Sibling Spouse Adult Child

Other

Age of individual with BPD

Please Describe Your Situation

Interest in teaching Family Connections or TeleConnections course

 Yes No

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