Step 1 of 3 33% Event Check InPlease check in to your event!Request ContactPlease provide the following information and we will get back to you shortly.HiddenSection BreakWhat's your connection to Recovery Beyond today?* Member Guest Volunteer Your Member Short Code:* Your participant short code is your first initial, last initial, birth month, day and year in the following format: FL10211901 Where First Last's birth date is 10/21/1901.Guest Name* First Last Guest Phone*Please enter (000) 000-0000 if you do not have or do not with to give a phone number.Guest Email* Please enter no@email.com if you do not have or do not with to give a phone number.Guest City* City How long are you planning on volunteering today?*Please enter a number from 0 to 24.Type of Volunteer* Activity Lead Activity Support Peer Lead First Aid I am attending:* Virtual Group Activity In Person Group Activity Recovery Coaching (One-On-One) I am attending:* Virtual Group Activity In Person Group Activity Virtual Group Activity* RB Live Training & Education Virtual Huddle In Person Group Activity* Hiking Mount Ellinor Sailing Trail Running & Walking Community Social Hiking Mountaineering Camping Paddleboarding Kayaking Biking Backpacking Cold Plunging Pickleball Snowshoeing DEIB Committee Peer Advisory Council Did you receive a ride to this activity/event? Yes No Name of person who gave you a ride First Last Please briefly describe what you would like to discuss*HiddenRequest ContactPlease provide the following information and we will get back to you shortly.I am:* A current Member Interested in becoming a Member Please Enter Your Member Short Code:* Your member short code is your first initial, last initial, birth month, day and year in the following format: FL01311990 Where First Last's birth date is 01/31/1990.Name* First Last Please contact me via:* Phone Email Phone or Email Phone # for Contact*Email for Contact* Please briefly describe what you would like to us to contact you about*New MemberPlease create your new member record.Name* First Last Email* If you don't have an email address, please input "no@email.com".Phone*Please enter (000)-000-0000 if you do not have a phone numberAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about us?* Friend/Family Treatment Provider Probation officer Emergency Department Reason for Referral* Select All Housing Employment Education Connection to treatment Connection to recovery community Recovery support Probation Overdose Co-occurring Multiple treatment episodes Other Reason for Referral, if Other: Demographic InformationDate of Birth* MM slash DD slash YYYY Race* Black or African American Asian Native Hawaiian/Pacific Islander Alaska Native White Native American Other Refused Race, if Other: Ethnicity Hispanic or Latino Not Hispanic or Latino Refused Gender* Male Female Transgender Non-binary Other Refused Gender, if Other: Do you have health insurance?* No Yes Unknown Where do you live?* Housed Unhoused Shelter Recovery Residence Residential Treatment Institution Halfway House Other Refused Describe your living situation, if Other: Please select which recovery path(s) you use:* Abstinence 12-Step Recovery Support groups Natural Recovery Peer Recovery support Medication-assisted Recovery Harm Reduction Alternative/Holistic Recovery Other Unknown Recovery Path, if Other: Highest Level of Education Never Attended Primary/Elementary (1st - 6th) Junior High (7th & 8th) Some High School (9th - 12th) High School Diploma/Equivalent Some College/Vocational School Vocational/Technical Diploma Associate's Degree Bachelor's Degree Some Higher Studies Master's/PhD Are you a Military Veteran? Yes No Contact PreferencesI am interested in:* Group Recovery Activities 1-on-1 Recovery Coaching Support The purpose of the disclosure authorized in this consent is to receive recovery support. I understand that my alcohol and/or drug treatment records are protected under the Federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. Pts. 160 &164 and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time. I understand and agree to the following: 1. I grant permission for a volunteer to call me at the above phone number, email, and/or address to support me in my recovery. 2. Each time the volunteer calls, he/she will be asking me how my recovery is progressing and if I am in need of additional support (i.e., meetings in area, recovery community centers, safe/sober housing, social events, other resources). 3. At the time of the call, if I am in need of a referral to a treatment program or detox unit, I will be assisted in finding a program, if I so desire. 4. If at any time I decide not to take part in this program, I will contact the center or tell the volunteer when he/she calls.HiddenConsent I agree to the aboveHiddenBest Days to Call: Select All Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays HiddenBest Time to Call Morning Afternoon Evening Anytime New VolunteerPlease create your new volunteer record.Name* First Last Email* If you don't have an email address, please input "no@email.com".Phone*Please enter (000) 000-0000 if you do not have a phone number.Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Demographic InformationDate of Birth* MM slash DD slash YYYY Race* Black or African American Asian Native Hawaiian/Pacific Islander Alaska Native White Native American Other Refused Race, if Other: Gender* Male Female Transgender Non-binary Other Refused Gender, if Other: Are you a Military Veteran?* Yes No Monthly Quick ChecksPlease complete the following Monthly Assessments. ALL fields are required. You will be completing the Brief Assessment of Recovery Capital, Outcome Rating Scale, and Craving Rating Scale.Your Member Short Code:* Your member short code is your first initial, last initial, birth month, day and year in the following format: FL10211901 Where First Last's birth date is 10/21/1901.Email If you would like an email notification that you have submitted your assessment, please enter your email here.Brief Assessment of Recovery Capital(BARC-10) Please indicate your level of agreement with the following statements:There are more important things to me in life than using substances* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree In general I am happy with my life* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree I have enough energy to complete the tasks I set myself* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree I am proud of the community I live in and feel part of it* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree I get lots of support from friends* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree I regard my life as challenging and fulfilling without the need for using drugs or alcohol* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree My living space has helped to drive my recovery journey* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree I take full responsibility for my actions* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree I am happy dealing with a range of professional people* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree I am making good progress on my recovery journey* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree Outcome Rating Scale (ORS) Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life, where marks to the left represent low levels and marks to the right indicate high levels.Individually (Personal well-being)Interpersonally (Family, close relationships)Socially (Work, school, friendships)Overall (General sense of well-being) Craving Rating Scale (CRS)Cravings (Over the last 7 days)Cravings (In the last 24 hours)