Facilitating Grief Support Groups After Substance-Use Death

Registration

Thank you for your interest in the Facilitating Grief Support Groups After Substance-Use Death. Please fill out the information below and mail a check for $100 to: NYS Tribute Foundation, 1 S Family Drive, Albany, NY 12205 or Credit Card payments may be made by calling 800-291-2629. Thank you.

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* 1. Participant Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Which training would you like to register for?

November 14 - 15

April 3 - 4

May 15 - 16

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* 3. Emergency Contact Information

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* 4. Do you have any Dietary Restrictions?

Yes

Please specify