Support Group Reg Form | CopingAfterSuicide

Support Group Registration form

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

If you have any difficulties, contact copingaftersuicide.assistant@gmail.com - we're here to help

When he/she/they died, they were:

When he/she/they died, I was:

My loved one's name:

Thank you for registering. You'll be receiving a confirmation email with the Zoom link and additional information soon.The email will be coming from copingaftersuicide.assistant@gmail.com.If you haven't received an email within 3 days, please check your junk/spam folder.

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

Signature

As parent/guardian, I have spoken with Jenny Baltazar. I accept the terms and conditions, and I understand that the non-refundable registration fee cannot be prorated or partially refunded.*

Parent/Guardian Signature

For Teens Group registrations only

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.*

(after you hit this button, please allow 3-5 seconds for the payment screen to load)

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