Name:
Email Address:
Address 1:
Address 2:
City:
State:
Zip Code:
Work Phone:
Cell Phone:
Demographics: I have ADHD
My Spouse/Partner has ADHD
My Child/ren has ADHD
My clients/patients has ADHD
None of the above
I would like to volunteer to: Start a support group in the community.
Become a virtual support group facilitator.
Select the audience that you would like to serve: Parents of Children Ages 5-12
Parents of Children Ages 13-18
Parents of Young Adults (18-25)
Adults with ADHD
Virtual Support Group Facilitators - What days are you interested in? Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Virtual Support Group Facilitators: What time(s) are best for you? (Use your time zone to specify what time is best for you) 9:00 am - 12:00 pm
12:00 pm - 3:00 pm
3:00 pm - 6:00 pm
6:00 pm - 9:00 pm