The Survivor Support Group takes place three times a week. Fill out the registration form below and someone will contact you with more information.

Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Are you willing to submit to a background check?
- Yes
- No
The Elgin Survivor Support Group is at a non-disclosed address. The address of the group that fits your needs will be disclosed at the time of your interview and acceptance with the Peer Specialist. Are you willing to keep the location of the group confidential?
- Yes
- No
Reason for Interest:

How You Can Help

Elgin Survivor Support Group