Registration for Next Step
Bereavement Support Group
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Is this your first time participating in a CSCDE program?
Yes
No
I would like to participate (check all that apply):
Second Monday of the month at 6:30pm IN PERSON in New Castle County office
Second Monday of the month at 6:30pm via Zoom with the New Castle County group
Last Thursday of the month at 3pm IN PERSON in New Castle County office
Last Thursday of the month at 3pm via Zoom with the New Castle County group
Unsure; would like more information
Submit
Should be Empty: