SuperMom Support Registration

SuperMom is a Collaboration of LCL | Mass LOMAP and WBA Parents' Forum

Only your name and email is required, but we are grateful if you can complete the remaining information.

Contact Information

First Name

Last Name

Preferred Pronouns

If other pronouns, please provide

Email Address

Mobile Phone

Home Address City

Home Address State

Home Address Zip

County

Demographic Info

Gender Identification

Birthdate

Required format: MM/DD/YYYY

Ethnicity

Marital Status

Bar Admission Status

Law School

Graduation Year

Employment Status

NOT a lawyer?

Check here

If other, please specify:

Name of individual referral source, if desired:

LCL Staff may use email to communicate with you about matters such as scheduling, referrals, information about services, and for follow-ups to check on how things are going. Check below if you'd prefer NOT to be contacted following your last scheduled LCL session.

Opt Out

LCL maintains an email listserve for lawyers in recovery. To be added, please provide your preferred email address:

Contact Information

Bar Association	Board of Bar Examiners
Board of Bar Overseers	Client
Colleague, Friend, or Family	CPCS
Employer	Exhibitor Table at Event
Internet Search	Judge/Judiciary
Law School	LCL \| Mass LOMAP Staff
Mass Lawyers Weekly	Other:
Practicing with Professionalism	Presentation by LCL \| Mass LOMAP Staff
Print Advertisement	Read Article by LCL \| Mass LOMAP Staff
Recovery Meeting	SJC Standing Committee on Lawyer Well-Being
Social Media	Treatment Provider
Web Advertisement