Recovery Revival Application Form

Recovery Revival Application

Let's Get to Know Eachother
Full Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about Recovery Revival?
Other
Please tell us a little bit about your alcohol journey so far:
What's calling you to Recovery Revival now?
How long have you been alcohol-free?
What kind of support are you most interested in?
Recovery Revival is an intimate, interactive experience, and participants are asked to attend at least 10 of the 12 live sessions. Are you able to make that commitment?
If you could experience one meaningful shift over the next 12 weeks, what would it be?
Thank you for applying to Recovery Revival! I'll personally reach out to you via text within 24 hours to connect, answer any questions, and talk about the level of support that may be the best fit for you.

With love,

Emily
Should be Empty: