Carry the message of recovery as an Alumni Community Connection

I want to help carry the message of recovery by serving as a Harmony Alumni Community Connection.*
- Yes
- No
I am active in my local recovering community.*
- Alcoholics Anonymous
- Narcotics Anonymous
- Cocaine Anonymous
- Other
- None
I also attend the following meetings: (optional)
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Sobriety Date*
MM
DD
YYYY
I have been clean/sober for the last 12 months.*
- Yes
- No
Comments
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Community Connection