Thriving Survivor Registration Form
Please fill out this form to register for our Thriving Survivor class.
Name
*
First Name
Last Name
Email Address
*
Required for Zoom link
Phone Number
Optional
County of Residence
*
If you are not in North Carolina, please type "Out of State"
I understand that I am signing up for Thriving Survivor classes with the Brain Injury Association of North Carolina. I am giving my name and email address so that I can receive the Zoom link for classes. I understand that this information is being given for this purpose only.
*
Yes, I understand.
I understand that I am participating in this activity at my own risk.
*
Yes, I understand.
Submit
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