New MemberSite*Barre - Turning Point Center of Central VermontBennington - Turning Point Center of Bennington CountyBrattleboro - Turning Point Center of Windham CountyBurlington - Turning Point Center of Chittenden CountyMiddlebury - Turning Point Center of Addison CountyMorrisville - North Central VT Recovery CenterNewport - Journey to Recovery Community CenterRutland - Turning Point of RutlandSaint Albans - Turning Point of Franklin CountySaint Johnsbury - Kingdom Recovery CenterSpringfield - Turning Point Recovery Center of SpringfieldWhite River Junction - Upper Valley Turning PointHow did you hear about us?*Friend/FamilyTreatment ProviderProbation officerEmergency DepartmentName* First Last Phone*If you don't have a current phone number, please input "No phone".Email* If you don't have an email address, please input "no@email.com".Date of Birth* Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender*MaleFemaleTransgenderOtherNonbinaryPrefer not to answerRace*WhiteHispanic, Latin, or Spanish OriginBlack or African AmericanMiddle Eastern or North AfricanAmerican Indian or Alaska NativeNative Hawaiian or Pacific IslanderAsianMore than one raceOther
