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Resolving Assertively RSVP Form
Please fill out the registration form and someone will be in contact with you soon to provide more details regarding the group. If you need to reach someone about the group, please contact Dimica Lawrence at
dimica@aspiregroupnc.com
.
* Indicates required question
Email
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Your email
First and Last Name
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Your answer
Pronoun(s)
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Your answer
Home Address:
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Your answer
City:
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Your answer
State:
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Your answer
Zip Code:
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Your answer
Date of Birth:
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MM
/
DD
/
YYYY
Phone Number:
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Your answer
Is it OK to leave you a message?
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Yes
No
Is it OK to send you a text?
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Yes
No
Email Address:
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Your answer
Which July/August group dates do you plan to attend?
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July 14th
July 28th
August 11th
August 25th
Required
Can you provide some brief details regarding your presenting concern? This is not required, but can be helpful in preparing resources to support you during group.
Your answer
What is the best way to follow up with you?
*
Phone call
Email
Text
Thank you for providing this information! We will be in touch soon.
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