Support Group Reg Form | CopingAfterSuicide

Support Group Registration form

When he/she/they died, they were:

When he/she/they died, I was:

My loved one's name:

Have you lost someone else to suicide?

Yes (please complete the information about the loss below)

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.

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

As parent/guardian, I have spoken with Steve Karaiskos. 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

Registration fee paid by another entity. Adminstrative fee only - $50

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.*

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