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This should be descriptive of the City/Town or area you live in. No need to add Project Semicolon or Chapter to your name & please don’t use States or Counties as there are multiple cities in a particular county or state. Name examples: A City – Denver | A City Slogan – Mile High City | An “area specific” landmark – Grand Canyon. Naming Rules

Phone number of the Leader (for internal use only). This address is used publicly for users to find your chapter. Please use the address closest to your approved area. This email address is not publicly shared. You will receive all communications from the leadership team at this email address. This should be descriptive of the City/Town or area you live in. No need to add Project Semicolon or Chapter to your name & please don’t use States or Counties as there are multiple cities in a particular county or state. Name examples: A City – Denver | A City Slogan – Mile High City | An “area specific” landmark – Grand Canyon. Naming Rules Chapter Name* Mental Health Professional?* Yes No Leader’s Full Name* Phone* Email* Chapter Location* Occupation* Your Website (optional) Briefly describe your lived experience with mental illness/madness, Disability, trauma, and/or neurodivergence.* Why do you want to start this chapter?* Chapter Image* Maximum file size: 3 MB T-shirt Size* SM MED LG XL XXL XXXL Submit