Mobilize Recovery 2021 Virtual Registration
Limited registration to participate in Mobilize Recovery 2021 virtually/online is now open. Registrations will be accepted on a first come, first serve basis. Registration will close once virtual/online capacity is reached, no later than August 31, 2021.

In order to register, you must commit to full participation online for all 3 days that virtual programming will be available (Saturday, September 25 - Monday, September 27). After registration, you will receive instructions to login to the virtual platform during the first week of September 2021 and select your virtual schedule and workshops. More information will be provided following registration later in August from the Mobilize Recovery team via email (info@mobilizerecovery.org).

*If you have already been accepted to attend virtually through the original application process, there is no need to submit an additional registration through this form.

**Applications for in-person participation have closed and participants have been notified. Registration via this form is for virtual/online participation ONLY.

*REGISTRATION IS FREE*
Sign in to Google to save your progress. Learn more
Email *
Your Full Name *
Your Preferred Pronouns
Your Mobile Phone Number *
Are you able to commit to all three conference dates - September 25, 26 and 27? Please note we are only accepting attendees who can participate all three days. *
Your Home State *
Photo/Video Release: Mobilize Recovery may record and/or reproduce in written form or on audio or video tape, photographs, or other media (including digital media) your participation in the event (collectively "recordings"). I agree that Mobilize Recovery will be the sole owner of any such recordings and can use them in any way it sees fit, without needing any further permission from me. I agree that the rights granted to Mobilize Recovery above are given without limitations, are worldwide, and they will apply to any format or manner of use and any means, media or technologies now known or created in the future. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Recovery Advocacy Project. Report Abuse
Google Forms