Support Group Interest Indicator Form

Support Group Interest Indicator

Back to Start a Support Group

All information provided is held in strict confidence and at no time will be distributed to other organizations.

Yes, I am interested in establishing a DBSA chapter in my area. I understand that the main purpose of DBSA Chapters is to offer support groups to share information and mutual support related to members' experiences with depression and bipolar disorder, and that the primary participants in support group meetings are persons diagnosed with one of these disorders or those who believe they may have a mood disorder. Meetings are open to the public and free of charge.

Choose one option below:

Please send me a DBSA Chapter Start-Up Guide in electronic form via email. (This is the most cost effective option, which allows DBSA to allocate funds to serve the public in other ways.)

Please send me a DBSA Chapter Start-Up Guide in hard copy via regular postal mail.

Proposed area to be served:

My contact information:

Name:

Street address:

Address (cont.):

City:

State:

Zip/Postal Code:

Country (optional):

Daytime phone:

Email:

Others who will assist me:

Name 1 (required):
Name 2 (required):
Check here if we have your permission to share your contact information with others in your area who are also interested in starting a DBSA chapter in the community.

Back to Start a Support Group

Site last updated: May 30, 2006

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