Peer Pod sign-up form

Title *

Name *

First

Last

Email *

Phone

Which of our Peer Pod sessions are you interested in attending?

Which of the Women's sessions would you like to attend?

Which of the Men's sessions would you like to attend?

Have you attended a peer support group before? (in relation to MS or not)?

What are you looking to gain out of our Peer Pod sessions?

Meet new people who understand what I'm going through whilst supporting each other
A place to share my experiences/feelings about MS and other matters in my life
Gain encouragement from others
Other

What is not listed that you would like to gain from our sessions?

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.