Meaningful Conversations - Living with Parkinson's Disease - Request Information

2nd Tuesday of each month
2:00 - 3:00 pm
Via Zoom Conferencing

If you are living with Parkinson's Disease, this group provides support for coping with the physical, emotional, and social impact of the disease. Some meetings will include practical information and resources presented by experts in the field. Facilitated by Michelle Goldberg, LCSW-C. Funded by the Maryland Association for Parkinson Support, Inc. Co-sponsored by the Edward A. Myerberg Center.
Name Name First Last
Your email address
Phone number Phone number - ### - ### ####
Your Zip Code
In terms of your interest in the group, are you

In terms of your interest in the group, are you a person who has Parkinson's Disease a family member of someone with Parkinson's a caregiver for someone with Parkinson's Other (please specify) Other (please specify)

You may select more than one if applicable.
Please share your age.

Please share your age. Under 18 18-24 25-34 35-44 45-54 55-59 60+
Please share your pronouns.
Pronouns are the part of speech used to refer to someone in the third person. We want to know how to respectfully refer to you.

Please share your pronouns.
Pronouns are the part of speech used to refer to someone in the third person. We want to know how to respectfully refer to you. She/her/hers He/him/his They/them/their Other Other
Do you affiliate with a particular religion?

Do you affiliate with a particular religion? Yes No Prefer not to answer Other Other
What is your religious affiliation?
How did you learn about this program?

How did you learn about this program? JCS e-newsletter JCS website Social Media Print Flyer or Poster JCS Staff Person The Associated Communications (e-news, posts, calendars) AgeWell Baltimore Other Agency of The Associated (JCC, CHAI, Myerberg Center, CHANA, etc.) Synagogue / Temple Community Professional or Organization Press/Media (Article, Ad, Calendar) Friend or Family Member Other Other
Please check if you would like to receive JCS News & Notes, our monthly e-newsletter with helpful resources, tips, and program info.

Please check if you would like to receive JCS News & Notes, our monthly e-newsletter with helpful resources, tips, and program info. Yes, please add me to your distribution list.

JCS respects your privacy. We will never share your contact information with another organization and we will not send you frequent emails.