Registration

In order to create discussions or reply to discussions please register to become a member

Please tell us a bit about yourself so we can begin to build your Toolbox. If you’re concerned about how your information will be used you might like to review our Privacy Policy.

Once you sign-up, we’ll send you an email confirmation. Email from the address: autoinfo@alcoholhelpcenter.net will be sent to you (so you may want to check bulk email folders if you don't see the email right away.)

Are you a health care professional or a researcher? Please note that use of this program is for your personal, non-professional use. Yes
No
1. The Nickname I'd like to use for this program is:
(Please note that others in the Support Group will see your Nickname. To protect your privacy, please choose a Nickname that is different from your real name.)

2. The email address I’d like to use for this program is:
If you're concerned about your privacy, we suggest signing up for an anonymous Yahoo or Hotmail email address.

3. The password you would like to use for this program is:
(Strong password required. Must be at least 8 characters, contain at least one lower case letter, one upper case letter and one digit.)

Please confirm your password by retyping it here:

4. You are: male
female
5. My Country:

6. I am in this age range:

7. How much would you say that the average drink costs you?

8. Right now you are drinking approximately this many drinks per day:

9. Your goal is to:
Cut down to this many drinks per day: Stop drinking altogether I'm not sure what my goal is at this point

10. What best describes your occupation (please select the best answer)? Full-Time StudentStay at Home Mom or Dad
ManagementTeacher or Professor
Administrative, Financial or Clerical Sales or ServiceTechnologist or Technical Occupation
Occupation in Farming, Forestry, Fishing or MiningTrades, Transport or Equipment Operator
Occupation in Processing, Manufacturing or UtilitiesUnemployed at Present or on Work Leave
Professional Services (e.g. certified accountant, lawyer, doctor)An Occupation not Listed

11. What is the highest level of education you've completed (please select one answer)? Attended grammar schoolCompleted grammar school (8th grade)
GEDGraduated high school
Attended high school (did not complete)Graduated college
Attended college (did not complete)Masters
Some post graduateMD
Doctorate

12. Please check this box to acknowledge that your non-personal information will be used for purposes of improving this program. Your use of this program is subject to your data being used for research purposes. We do not collect or analyze individual statistics.

After you click "Next" we’ll confirm your registration, create your Toolbox, and bring you to your personal homepage.

Please Note: By clicking "Next" you acknowledge that this program is for educational purposes only and is not to be used as a substitute for a consultation or visit with your family physician or other healthcare provider.