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* 1. Attendee Info

Due to the nature of the issues discussed at MOVE, it is our top priority to ensure that each attendee is safe and in a healthy place to engage in the conversation. The questions below help our team better guide the conversation at MOVE. We believe your story is important, and we will not share information provided here unless we believe that you are in immediate danger of hurting yourself, or someone else.

We value your honesty and your willingness to share with us.

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* 2. Have you ever struggled with any of the following issues? You may select more than one box in your response.

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* 3. If you selected any boxes, please explain.

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* 4. If you checked that you've struggled with any of the issues listed, please choose an answer that best corresponds to the last time you experienced the issue selected.

  1 week - 6 months ago 6 months - 1 year ago 1 year - 3+ years ago
depression
addiction
anxiety
self-injury
trauma
eating disorder
thoughts of suicide
other

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* 5. Are you currently receiving counseling or treatment from a mental health professional? Please explain.

*Please note that some of the material discussed at MOVE may be intense and potentially triggering. If you believe that a detailed discussion of depression, anxiety, and suicide could be harmful to your current recovery process we strongly encourage attendees to consult with their mental health professional before coming to this conference.*

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* 6. Thank you so much for sharing with us and providing your RSVP for the MOVE: Focus Conference on Friday, October 16, 2015.

Admission to the event costs $30. In order for you spot to be confirmed please visit https://www.classy.org/cookeville/events/move-focus-upper-cumberland/e55465.

You must submit your receipt confirmation number here. If you purchase your ticket at a later time you should email it directly to MOVE@twloha.com with the name of the attendee(s) it is for.

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