Support Group Reg Form 2026 | CopingAfterSuicide

Support Group Registration Form

Please complete this form on a computer rather than on a phone or tablet, if possible.

This form is part one of two necessary to register. The second form will pop up when you hit the button below labeled "Proceed to Checkout".

If you have any difficulties, please contact copingaftersuicide.assistant@gmail.com

We are here to help.

First name

Last name

Phone

I am registering for the following group

I am registering as a...

I've had an intake conversation with the facilitator of the group I'm registering for

I lost my...

He/She/They died on

Month

Day

Year

When he/she/they died, they were:

When he/she/they died, I was:

My Loved one's name:

I accept the terms and conditions and I understand that the non-refundable registration fee cannot be prorated or partially refunded.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Non-refundable registration fee payable in full. (choose one)

New Member$435

Continuing/Returning Member$395

I understand that I will receive emails from Coping After Suicide and its nonprofit collaborative partner, Rethink The Conversation, and that my contact information will not be shared with any third party.

We process each registration personally and you'll receive your confirmation email with Zoom links and other important information within 3 business days. If you don't see it, please be sure to check your junk/spam folder.

Support Group Registration Form

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