Survivor Day Dinner Registration

Survivor Day Dinner Registration

Join us November 14, 2026 for a meaningful gathering to support those who have lost loved ones to suicide. There is no cost to attend but, we do ask you complete this form to reserve your place. Doors open at 6PM at the SOWELA Hospitality Center at 3841 Sen. J Bennett Johnston Ave, Lake Charles, LA 70615.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Have you attended this event before?
Loved one you lost to suicide:
First and Last Name
And:
First and Last Name
Guest attending dinner with you:

First NameLast Name
Guest's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Guest's Email Address
example@example.com
Should be Empty: