Language
English (US)
Navigating Grief After Homicide
An Online Support Group for Loved Ones of Homicide Victims
Registration Form
Tuesday, January 19, 2020 at 7:00 PM – 8:30 PM
First Name
*
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Optional Information:
What is your last name
What is the name of your loved one who was taken by violence?
What is your relationship to your loved one? (mother, father, son, daughter, brother, sister, etc.)
When did this homicide occur?
Where did this homicide occur (county, state)?
In what county and state do you currently reside?
What else do you want us to know about you, your loved one, or what happened??
How did you learn about our support group?
Newspaper
Online Ad
NCVAN Website
Referred by law enforcement or prosecutor
Therapist or clergy
Friend or family member
Do you have any upcoming court dates? If so, when and where?
Would a different day and/or time make this support group easier for you or others you know to participate? If so, please add options.
Submit
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