REGISTRATION

The Transformation Center's
2016 Regional Community Voice Gatherings
Peer Support: A Profession on the Move
~ Making Waves Toward the Future

Registration 9:45-10:30 Gathering 10:30-3:00

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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:

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* 5. Phone:

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* 6. Gathering(s) you are registering for: (Please note: A Gathering was already held in the Southeast)

Central: Thursday March 17th, Worcester Public Library, 3 Salem Square, Worcester

Boston: Thursday March 31st, SEIU 1199 Union Hall, 150 Mt. Vernon St., Dorchester

Western: Thursday April 28th, South Hadley Public Library, 3 Canal St., South Hadley

Northeast: Friday May 6th, Haverhill Pubic Library, 99 Main St., Haverhill

Metro Suburban: Friday May 13th, Arlington Library, 700 Massachusetts Ave., Arlington

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* 7. How would you describe yourself (can check more than one)?

Peer Worker

Peer Volunteer

Certified Peer Specialist

Recovery Coach

Clinical or Rehab Provider

MA State Employee

Supervisor

Administrator

Researcher

Funder or Policy-maker

Advocate, Friend, Family

Other community member

Details? (youth mentor, substance use advocate,etc....)

Thank you, we look forward to seeing you at the regional gatherings!
If you have questions, please call Ruthie Poole at the Transformation Center at (617) 442-4111 or email ruthiep@transformation-center.org.

Lunch provided
Registration is from 9:45-10:30 AM. The Gatherings will start at 10:30 AM and go until 3:00 PM