No More Red Dots - Participant Registration Form

To sign up for participation in NMRD events please fill out and submit the form below. Your privacy is highly respected.

Name *
Name
Address *
Address
Date of Birth *
Date of Birth
Phone Number *
Phone Number
Please answer the following questions:
Is the participant involved with the court system? *
What kind of work do you want to do? *
Are you currently employed? *
Are you able to work? *
Do you have transportation? *
Date of referral:
Date of referral:
By clicking submit below the submitter agrees to participate (or allow participation) in LIFE Hope Center events and in doing so releases the LIFE Hope Center and its associated organizations from any responsibility, liability and/or litigation resulting from their participation.
For more information and/or questions about the LIFE programs, please contact: Dr. Eddie L. Woods LIFE Hope Center (502) 262-4841