RESOLVING GRIEF - REGISTRATION

Thank you for your interest in joining our upcoming Resolving Grief training.

October 9, 2024 through October 30, 2024

4 Consecutive Wednesdays

5:00 PM - 8:00 PM Eastern
Time Zone Converter

Please complete the following form to finalize your registration. Thank you!

How did you hear about this workshop? *

If "Other", please list.

If "Referral", who can we thank?

Your First Name *

Your Last Name *

Your Profession *

Your Profession State & License No. (If Applicable)

Please Print Exactly How You Would Like Your Name to Appear on the Certificate of Attendance. *

Email Address (Must be the same as what you will utilize to join the Zoom meeting) *

Address 1 *

Address 2

Suburb/Town *

State *

Zip Code *

Country *

Phone Number Where You Can Be Reached During the Training (For tech support, further instruction, etc.) *

Please let us know if you require any special ADA assistance for this event.

We require that you review, sign and submit a copy of our Statement of Understanding. Please complete the Captcha requirement below and then choose "Next" to complete the forms.