Use this form to encourage others by telling them what challenges you face in your life and how you overcome them. Describe what outside sources you use, what attitudes or mindsets you changed, and what you continue to do to remain an overcomer of the challenges. **** Return to Registration Page ****

Name

First Name

Last Name

Email

Phone

(###)

###

####

Do you live in Wilmington, NC or surrounding areas?

YES

NO

Encouragement

Share your encouragement here.

When will you attend a support group session? The Affinity Support Group meets the 3rd Tuesday at 6 pm. (At least one-week prior registration is required for each session.)

MM

DD

YYYY

Encouragers Form

The Encouragers Component of The Well-Being Triangle