Application Fee:  $25.00

Take time to provide as much information as you can on your application. There is plenty of room to write your responses to the application questions. You can save your work at any point and come back later to finish it.   We want to make sure that you quality and will fit into this social anxiety group treatment therapy, so that you can be on the path to overcoming social anxiety for good.   

This application form is for the local therapy group that runs every Saturday within the dates specified.  


At the time of application, you must be through session four (4) of the audio/video series. Please do not fill out this application unless you are working in session four or beyond.
Please type correctly and check your address. This is the only manner in which we can respond to your application.
No P.O boxes