For adult (18+) women, non-binary folks, & trans men impacted by substance use.

Please fill out the information below. Voices facilitators are the ONLY ones who will have this information; we use it for confidential data reports. Once registered, your name will be on a confidential facilitator's list for attendance. You can find the meeting link on our LinkTree. Registration closes at 1pm the day of group. If you have any questions, please call our hotline (802-524-6575) or send us a message!

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* 1. What name would you like to go by in this group? Is it safe/okay to call you by this name outside of group?

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* 2. What pronouns would you like to use in this group? Is it safe/okay to use them with you outside of group?

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* 3. If you'd like us to use a different name and/or pronouns outside of group, please enter them here.

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* 4. What is your age?

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* 5. What county do you live in?

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* 6. What town do you live in?

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* 7. What activities would you like to do in group?

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* 8. Are any people that you cannot/do not want to be in group with?

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* 9. Is there anything else you want the facilitator(s) to know?

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