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This brief survey is to help us understand the background of each person that would like to participate in the Leadership Summit.  Thank you again for your valuable input so that we can continuously bring hope, resources and support to marriages with mental health and addiction challenges. We look forward to partnering with you.  Thank you for your leadership!

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* 1. Name

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* 2. What type of Leader are you?

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* 3. What organization are you with?

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* 4. Email

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* 5. Phone Number

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* 6. What are your social media handles?

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* 7. Are you passionate about marriages with mental health or addiction challenges?

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* 8. Why do you want to be a part of the Leadership Summit?

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* 9. What are you expecting from the Leadership Summit?

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* 10. What area to you think you want to volunteer with and it is okay if it is unknown at this time?

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* 11. What condition(s) or addictions impacts your life the most (click all that apply)?

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* 12. What is your faith (it is ok if you don't have one)?

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* 13. How did you hear about the Leadership Summit?

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* 14. Any questions or comments to inform us before the Leadership Summit.  Thank you in advance for filling this out and we look forward to meeting with you soon.

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