Type 3 Support Group 2 Registration

Thank you for your interest in this group, facilitated by ReCODE 2.0 Certified Coach, Monica Tarr.

Sessions are held on the Zoom platform; all details for attendance will be sent to you by the facilitator after completed registration; please allow a few days for processing.

This group meets every 3rd Thursday of the month, 2:00 - 3:30pm PT; 5:00 - 6:30pm ET, on an ongoing basis; your first session is the 2nd Thursday of the month after your registration.

Cost: The cost is $150 for a 6-month period, with a single 90-minute session per month.

Please Note: You will be automatically re-enrolled in this group at the end of the 6-month membership period; should you wish to discontinue your membership after 6 months, please contact apollohealthcoaching@ahnphealth.com to cancel.

If you have any questions, please email coaching@ahnphealth.com.

Please have your form of payment handy before beginning registration, so that it can be completed. If you leave this form without payment, you will not be registered in our system, and you will not be able to return to complete registration. We apologize for any inconvenience.

Refunds for our programs will be issued by a written request received within 48 hours of the end of the first session. All requests must be sent to apollohealthcoaching@ahnphealth.com. No refunds will be processed after 48 hours.

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* 1. First Name

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* 2. Last Name

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* 3. Address

Address

City/Town

State/Province

ZIP/Postal Code

Country

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* 4. Email Address

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* 5. Phone Number

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* 6. Are you a member of ReCODE or PreCODE?

ReCODE

PreCODE

Neither

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* 7. If no, is your loved one a member of ReCODE or PreCODE?

ReCODE

PreCODE

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* 8. If your loved one is a member, what is their name?

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* 9. Are you currently working with a ReCODE practitioner?

Yes

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* 10. Please share how you hope this group will be helpful to you (and/or your loved one):

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* 11. Unless there’s an emergency, I commit to attending all 6 sessions of the support group

Yes

Type 3 Support Group 2 Registration

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* 1. First Name

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* 2. Last Name

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* 3. Address

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* 4. Email Address

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* 5. Phone Number

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* 6. Are you a member of ReCODE or PreCODE?

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* 7. If no, is your loved one a member of ReCODE or PreCODE?

Question Title

* 8. If your loved one is a member, what is their name?

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* 9. Are you currently working with a ReCODE practitioner?

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* 10. Please share how you hope this group will be helpful to you (and/or your loved one):

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* 11. Unless there’s an emergency, I commit to attending all 6 sessions of the support group

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* 12. Anything else you'd like to mention: