Healing Conversations for Suicide Loss Survivors - Group Inquiry

2nd Thursday each month
7:00 - 8:30 pm
Via Zoom Conferencing

Thank you for inquiring about our Suicide Loss Survivors Support Group. Please complete the information below and a member of our grief support staff will contact you.

Name Name First Last
Preferred Phone Preferred Phone - ### - ### ####
Email
Please share your age.

Please share your age. Under 18 18-24 25-34 35-44 44-54 55-59 60+
Please share your pronouns.
Pronouns are the part of speech used to refer to someone in the third person. We want to know how to respectfully refer to you.

Please share your pronouns.
Pronouns are the part of speech used to refer to someone in the third person. We want to know how to respectfully refer to you. She/her/hers He/him/his They/them/their Other Other
Do you affiliate with a particular religion?

Do you affiliate with a particular religion? Yes No Prefer not to answer
What is your religious affiliation?
How did you learn about this program?

How did you learn about this program? JCS e-newsletter JCS website Social Media Print flyer or poster JCS staff person The Associated Communications (e-news, posts, calendars) AgeWell Baltimore Other Agency of The Associated (JCC, CHAI, Myerberg Center, CHANA, etc.) Synagogue/Temple Community Professional or Organization Friend or Family Member Press/Media (Article, Ad, Calendar) Other Other
Additional Comments