Support Group Registration Form

Question - Required - What is your connection to ALS? (Select all that apply)
Please make between 1 and 5 selections from the choices below.




Registration Information:




















* Facilitators will not give out attendess’ contact information to other attendess without verbal or written permission. It is suggested that group members following this rule as well.

* I will not share patient/family names or other identifying information with people outside of the group.

* I will not solicit for anything that is not Foundation-related, e.g. an offer to join your Walk team is okay, but a request to buy something you're selling is not okay.


* I will be courteous when others are speaking and will not interrupt.

* I will not criticize, blame, or shame other group members based on their comments

* I will use “I” statements to reflect my opinions, experiences and feelings.


* I will do my best to attend the group on a consistent basis so I can experience the greatest benefit of the group through my attendance and participation, while also supporting others. 


* I grant full permission for the Les Turner ALS Foundation to use photographs, or video recordings, or any other record of this event in which I may appear for any educational or fundraising purposes.



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