GriefShare Registration Form -

GriefShare for those who have lost a spouse.

Session One: April 29th – June 3rd – Session Two: July 29th – September 2nd

We will meet on Wednesday evenings from 6:00–8:00 PM in the First Colony Church of Christ Building, Education Wing, Room D232.

(There is an elevator to make it easy to access) We look forward to meeting you.

If you have any questions, please contact Charles Foster at (713) 504-3939 or email Charles at griefshare@survivingfromloss.com.

These classes were designed for the late spring and summer so that after class, you will be home before sunset.

Please fill out information and register below.

Name

Phone Number

Date of Birth (mm/dd/yyyy)

Address

City

State

Zip

Emergency Contact

How did you hear about this GriefShare?

Spouse Name

When was your loss?

Please share a little about your story.

This information is strictly private and is not to be shared with anyone. It is used only to help us help you.

This submitted form goes directly to Charles Foster, Executive Director of Surviving From Loss and GriefShare coordinator.