Join the Network

Complete this form to be added to the Harmony Alumni Network.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone
Work Phone
Email*
Sobriety Date*
MM
DD
YYYY
I was referred to Harmony by (if applicable):
My aftercare plan/program is (if applicable):
Message
Consent*
- Yes
I understand that by submitting this form I authorize Harmony Foundation to contact me for Harmony related purposes. I understand that this authorization is voluntary and that I can revoke it at any time through written notice sent to the Harmony Foundation.
Community Connection Program
- Yes! I want to help a new Harmony graduate
I understand that by selecting yes, I am authorizing Harmony Foundation to enroll me in the Community Connection Program for which I will be eligible after 1 year of continuous sobriety and regular participation in a 12-step program.
Private Alumni Facebook Page
- Yes! Email me an invite
I understand that by selecting yes, I am authorizing Harmony Foundation to send me an invitation to a private, closed group, Facebook page designed to be an open forum of communication for Harmony Alumni only.
Name
This field is for validation purposes and should be left unchanged.