Registration for Unraveling Motherhood
A Support Group for Postpartum Moms: 6 Week session starting 7/9/24, 10:00am -11:30am. Located at 242 Community Center, 648 S Wagner Rd #9002 Ann Arbor, MI 48103
Facilitated by Casey Cook, LMSW and Julia Kubek, PhD PMH-C
Customer Details:
Mother's Name
*
First Name
Last Name
Baby's Name
*
First Name
Last Name
Baby's Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Have you participated in a mom support group before?
Please Select
Yes!
No, This is my first time!
Are you interested in being included in a shared contact list for connecting with other moms in the group?
Please Select
Yes please!
No thanks!
Topics you are hoping are discussed:
Additional Information you would like us to know:
Submit
Should be Empty: