Register Your Support Group Edit Form TitleBy registering your support group with the Amputee Coalition, you are joining a nation-wide network of people who help individuals and families on their journey through limb loss or limb difference. As a registered support group, you will receive:Copies of our bimonthly magazine, inMotion, copies of First Step and educational materialsGroup website listing in our national Support Group Network and meeting listings on our calendar (thousands visit every week)Free participation at our Annual Support Group Leader Summit, held at the Amputee Coalition’s National ConferenceShared ideas, networking and news through our monthly support group leader conference callsPersonal support from our staff at supportgroups@amputee-coalition.org or 888.267.5669 x8146We recommend you provide a support group phone number and email that you wish to be shared on our Support Group Network and Support Group Meeting CalendarSubmitter's Information First Name Last Name Email Which emails field will this map to? Phone Is this an update to an affiliated support group currently listed on the Amputee Coalition website?Please select...Yes, this is an update to an existing support group that is currently listed on the Amputation Coalition website.No, this support group is new or is not listed on the Amputation Coalition website. What is changing?Group Info Name of Support Group Email Which emails field will this map to? Phone Website URL Facebook URL FaxSupport Group Leader Info First Name Last Name Email Which emails field will this map to? Phone CountryPlease select...AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChina - Hong Kong / MacauColombiaComorosCongoCongo, Democratic Republic of (DRC)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreat BritainGreeceGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIsrael and the Occupied TerritoriesItalyIvory Coast (Cote d'Ivoire)JamaicaJapanJordanKazakhstanKenyaKorea, Democratic Republic of (North Korea)Korea, Republic of (South Korea)KosovoKuwaitKyrgyz Republic (Kyrgyzstan)LaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedonia, Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar/BurmaNamibiaNepalNew ZealandNicaraguaNigerNigeriaNorwayOmanPacific IslandsPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak Republic (Slovakia)SloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandNetherlandsTimor LesteTogoTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited States of America (USA)UruguayUzbekistanVenezuelaVietnamVirgin Islands (UK)Virgin Islands (US)YemenZambiaZimbabwe Street City State (US)Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip State (Non-US)Support Group Mailing/Shipping Address CountryPlease select...AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChina - Hong Kong / MacauColombiaComorosCongoCongo, Democratic Republic of (DRC)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreat BritainGreeceGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIsrael and the Occupied TerritoriesItalyIvory Coast (Cote d'Ivoire)JamaicaJapanJordanKazakhstanKenyaKorea, Democratic Republic of (North Korea)Korea, Republic of (South Korea)KosovoKuwaitKyrgyz Republic (Kyrgyzstan)LaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedonia, Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar/BurmaNamibiaNepalNew ZealandNicaraguaNigerNigeriaNorwayOmanPacific IslandsPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak Republic (Slovakia)SloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandNetherlandsTimor LesteTogoTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited States of America (USA)UruguayUzbekistanVenezuelaVietnamVirgin Islands (UK)Virgin Islands (US)YemenZambiaZimbabwe Street City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Is the meeting location the same as mailing/shipping the same above?Please select...Yes, it is the sameNo, it is not the sameSupport Group Meeting Location CountryPlease select...AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChina - Hong Kong / MacauColombiaComorosCongoCongo, Democratic Republic of (DRC)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreat BritainGreeceGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIsrael and the Occupied TerritoriesItalyIvory Coast (Cote d'Ivoire)JamaicaJapanJordanKazakhstanKenyaKorea, Democratic Republic of (North Korea)Korea, Republic of (South Korea)KosovoKuwaitKyrgyz Republic (Kyrgyzstan)LaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedonia, Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar/BurmaNamibiaNepalNew ZealandNicaraguaNigerNigeriaNorwayOmanPacific IslandsPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak Republic (Slovakia)SloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandNetherlandsTimor LesteTogoTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited States of America (USA)UruguayUzbekistanVenezuelaVietnamVirgin Islands (UK)Virgin Islands (US)YemenZambiaZimbabwe Street City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Optional Meeting information or description to include on our support group calendar.Meeting Date/Time Information How Often Do You Meet?Please select...WeeklyMonthlyOther OtherMonthly/Weekly Date of Next Meeting Meeting Start Time HHPlease select...123456789101112 MMPlease select...01234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Edit this textPlease select...AMPM Meeting End Time HHPlease select...123456789101112 MMPlease select...01234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Edit this textPlease select...AMPMMonthly Please Specify How Often You Meet MontlyPlease select...Every MonthEvery 2 MonthsEvery 3 MonthsEvery 4 MonthsEvery 5 MonthsEvery 6 Months Which day of the week is your monthly meeting?Please select...SundayMondayTuesdayWednesdayThursdayFridaySaturday Which week of the month is your monthly meeting?Please select...firstsecondthirdfourthfifthlastWeekly Please Specify How Often You Meet Weekly:Please select...Every WeekEvery 2 WeeksEvery 3 WeeksEvery 4 WeeksEvery 5 WeeksEvery 6 Weeks Which day of the week?Please select...SundayMondayTuesdayWednesdayThursdayFridaySaturdayPersonal contact information collected from users of the Amputee Coalition web site and its services will not be sold or otherwise provided to organizations or commercial activities. 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