🌿 RECLAIMING ME: Wellness + Support Group RSVP Form

🌿 RECLAIMING ME: Wellness + Support Group RSVP Form

✨ Thank you for your interest in attending “Reclaiming Me” — a healing-centered support group for survivors ready to heal, grow, and rise. Please fill out the form below to reserve your spot.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
How did you hear about this event?
Your Victimization(s):*

Domestic Violence (Intimate Partner):Sexual Violence (Non-Intimate Partner):Other
If "Other", Please explain here:
Do you have any questions or specific support needs you’d like us to be aware of?*
💜 Thank you for your RSVP! We are honored to have you join us. You will receive a confirmation email with more details closer to the event. Please contact us at (719) 247-8190 or info@kbflc.org if you have any questions.
Should be Empty: