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* 1. Are you currently working/volunteering in Death and Dying?

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* 2. Please choose the categories that best describe your work

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* 3. Please describe your interests in death and dying?

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* 4. Have you completed or are you currently enrolled in an educational/training program related to death and
dying?

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* 5. Please list any relevant affilliations and experiences

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* 6. Are you interested in participating in an educational and activist group with other practitioners and students in these fields?

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* 7. Ideally, how often might you be available to meet in NYC?

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* 8. Please identify any of the ways you might like to contribute

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* 9. Contact Information

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* 10. If you could change one thing about end-of-life experiences what would it be?

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