New Support Group Submission

BIAC is excited to learn more about your Brain Injury Support Group! Please complete the form below with your group’s information and a member of the BIAC staff will followup up promptly with more information aboout how BIAC can support and promote your group.

NOTE: If you would like to update the information about an existing group that is published to the BIAC site, please use this form instead.

City – Group Name

For Example: “Denver – Main Street Hospital Survivor Group” If the group does not have a name, just write the city where the group meets.

Intended For

For example: Adults with a TBI or Teens with all types of BI and their parents

Meeting Site

For Example: The MainStreet Coffee Shop or The basement of St. John Church

Meeting Address

Street Address Address Line 2 City State ZIP Code

Day(s) & Time(s) of Meeting

For Example: The first tuesday of the month at 6pm or Weekly on Monday afternoon at 3pm

Group Contact/Leader Name

Note: This information will be shared publically

First Last

Group Contact/Leader Phone

Note: This information will be shared publically

Group Contact/Leader Email

Note: This information will be shared publically

Addition Information/Comments

New Support Group Submission

Top Supporter

2024 Cathleen's Cause Golf Tournament

Friends & Supporters

Join Our Mailing List