MSAM Event Registration Harold P. Kirby, LCSW, BCDPlease choose which event you would like to attend. 6 Week Mindfulness Class starting January 5, 2019 @ 10 am. The recommended donation is $30, paid at the time of each class. If the donation amount is above your budget, we ask that you give whatever amount that you believe is generous. OCD support group. Meets the first and third Tuesday of each month. Call Harold at 610-517-3127. Pendle Hill Day Long Retreat - Saturday, November 17thName First Last Birth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Have you previously received any type of mental health services? (psychotherapy, psychiatric services, etc.)YesNoAre you currently taking any prescription medication?YesNoPlease list any specific health problems you are currently experiencing that you may need accommodation for in group.What do you consider to be some of your strengths?What do you consider to be some of your weaknesses?What would you like to accomplish out of your time in this group?