Expression of interest
Eclipse is a support group for adults who have survived a suicide attempt, regardless of when the attempt happened. Please register your interest here for future group dates, or to find out more information on the program.
Name:
*
First Name
Last Name
E-mail Address:
*
example@example.com
I would like: (select all that apply):
Register for the Upcoming Eclipse Program, commencing on Tuesday 28th April 2026
Someone to contact me regarding the program
To be notified when other dates become available
I would like:
To be notified when other dates become available
Someone to contact me regarding Eclipse
To help us better plan dates into the future, please let us know what days/times work best for you. (OPTIONAL)
Rows
Mornings
Afternoon
Early Evening
Anytime
Unsure or not available
Monday
Tuesday
Wednesday
Thursday
Friday
Weekends
Phone Number:
Format: (000) 000-0000.
What days and times are best to contact you?
Referral Agency (OPTIONAL)
Next Steps
Mission Australia
No referral
Other
Phone Number:
Format: (000) 000-0000.
Lifeline South Coast
For any questions or more information please email programs@llsc.org.au
Submit Application
Should be Empty: