MEMBERSHIP APPLICATION

All women (18 and older) who have had a traumatic brain injury and have had lasting symptoms associated with their injury (longer than one month) are encouraged to apply. To be a part of our community, fill out the application below.

See our "Updates" section on the bottom our home page (here) for current information about when the next sessions are starting. Depending on the amount of applications we receive for each session, you may be put on a waiting list. We plan to start new sessions every few months.

Thank you for your interest in joining our community!

First Name

Last Name

State, Country

Age

Date of your traumatic brain injury

Why would you like to join one of our support group sessions?

Would you like to be a participant or a listener?

Participant

Listener

I'm not sure

What session are you interested in joining?

May/June 2021 session: Wednesdays at 8pm Eastern Time

Contact me about the next session - I am unavailable for the above option(s)

Are you able to attend all 6 meetings of our May/June 2021 session (May 12th, May 19th, May 26th, June 2nd, June 9th, and June 16th)?

Yes

How did you hear about Healing Brain Project?

By checking this box, I indicate that I agree to the rules of membership, and I agree to Healing Brain Project's terms of use and privacy policy (links below)

Rules of Membership / Terms of Use / Privacy Policy

Thank you for your application!

A confirmation email has been sent to the email you provided

HEALING BRAIN PROJECT

Navigating post concussion symptoms together

MEMBERSHIP APPLICATION

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