Use this form to describe what you can give that will improve the well-being of women such as information on services, financial support, household items, etc.. ************ Return to Registration Page ***********

Name

First Name

Last Name

Email

Phone

(###)

###

####

Do you live in Wilmington, NC or surrounding areas?

YES

NO

Your Resources

Describe what resources you are willing to share.

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

Resources Form

Resources Component of The Well-Being Triangle