Membership Application
If you are interested in becoming involved with Mixed Recovery Team, please fill out the details below.
Name
First Name
Last Name
Interest in Mixed Recovery?
Emotional Support
Self-Improvement
Service Work
Paid Work
Training and Classes
The Mixed Recovery System
Religious / Faith Based Support
Teaching Religious or Self-Care Practices
Small Business Listing
Joining the Team
Other
Belief systems observed / applied
Atheism
Christianity
Islam
Buddhism
Universal Truth
12 Step Recovery
Sikhism
Judaism
Jainism
Hinduism
Agnostic
Mixed Recovery
Other
List your certificates, degrees and areas of specialty, including self-taught?
Social Conditions Under Improvement
Codependency
Depression
Addiction
Alcoholism
Trauma
Anxiety
Emotional Abuse
Anger
Personal Loss
Personality Disorders
Financial Hardship
Other
Self Care Rituals
Confession
Grounding
Yoga, Pilates, Tai Chi, etc.
Meditation
Time in Nature
Self Awareness / Recovery Work
Selflessness / Service Work
Prayer
Exercise
Nutrition
Education
Rest and Healing Time
Crying
Fasting
Reading
Wudu and Salat
Other
What is your interest in Mixed Recovery, Inc.?
What would you like help improving in yourself?
In one paragraph what would you potential clients to know about you?
Profile Introduction
Location (City, State and Country)
Languages Spoken
Hyperlinks
Please list any links to the resources you like us to consider for your application.
Website Hyperlink
Email Address
Facebook
Instagram
YouTube
Online Group Link
Other
Upload your logos and or profile picture
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