Grief Support Group Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Mailing Address (Please include Apt/Unit Number) REQUIRED Please fill out this field. Please enter valid data.

CELL phone number (We may text you to provide urgent weather date/time changes) REQUIRED Please fill out this field. Please enter a phone number.

Email Address (We may email you to provide important date/time changes or resources for your sessions.) REQUIRED Please fill out this field. Please enter an email address.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Which is your parish? REQUIRED SLE Other Parish: PLEASE NOTE - because of limitations on space, we will prioritize SLE parishioners. We will, however, be happy to connect you with grieving ministries at your parish, Please fill out this field.

Because this is Saint Luke's first year of Bereavement Ministry, we are limiting registration to 60 parishioners of SLE. If we have open spaces, we will prioritize SLE parishioners on our waiting list, and then members of other parishioners. Thank you for your understanding.

I would like to be placed on the 2025 waiting list if I miss the 2024 group. REQUIRED YES NO Please fill out this field.

Sex: REQUIRED Male Female Please fill out this field.

Your age group: REQUIRED 18-25 26-35 36-45 46-55 56-65 66+ Please fill out this field.