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Addiction Loss Group Night Registration

Please fill out the form below if you plan on attending this month’s Addiction Loss group night.

Tuesday, October 9th @ 6:30 pm

5110 W. Main St, Belleville, IL 62226

Today's Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Phone*
Email*
COVID-19*
I agree that I will not attend group if anyone in my party has been experiencing COVID-like symptoms or has received a positive COVID test in the last 14 days.
Masks Required*
I understand that masks are required at group night, regardless of vaccination status. I agree to wear a mask at group night, unless instructed otherwise by a Heartlinks counselor.
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