Exit this survey Intl Survivor of Suicide Day 2014 RSVP for Illinois Question Title * Full Name:(Example: Rachelle Jervis, MBA) Question Title * Email Address:(Example: illinois@AFSP.org) Question Title * Mailing Address:(Example: AFSP, 2906 Central St, #293, Evanston, IL 60201) Question Title * Which Int'l Survivor of Suicide Day Event Location Site Are You RSVPing to Attend? Arlington Heights, IL @ Alexian Center, 3436 N Kennicott, Arlington Heights, IL 60005 Belleville, IL @ Heartlinks Grief Center, Family Hospice, 5110 W Main St., Belleville, IL 62226 Belleville, IL @ Karla Smith Foundation Location, Peace Chapel, 10101 W Main St., Belleville, IL 62269 Dixon, IL (Sauk Valley) @ Sinnissippi Centers, Dixon office - Training Center, 325 Illinois Route 2, Dixon, IL 61021 Machesney Park, IL (Rockford Area) @ Riverside Community Church, 6816 N 2nd St., Machesney Park, IL 61115 Naperville, IL @ Fox Valley Institute, 640 N. River Rd., Suite 108, Naperville, IL 60563 Peru, IL @ Illinois Valley Community Hospital's Community Room in the Peru Mall, 3940 Route 251, Suite E-1, Community Room, Peru, IL 61354 Springfield, IL @ Lincoln Prairie Behavioral Health Center, 5230 S. 6th Street Road, Conference Room, Springfield, IL 62703 Woodstock, IL @ Resurrection Catholic Church, 2918 S. Country Club Rd, Woodstock, IL 60098 (South of Loyola's Retreat & Ecology Center) Question Title * Type of Loss(es): Husband Wife Partner Boyfriend Girlfriend Daughter Son Step Daughter Step Son Grand Daughter Grand Son God Daughter God Son Mother Father Grandmother Grandfather Brother Sister Twin Brother Twin Sister Aunt Uncle Cousin Friend Classmate Colleague Neighbor Student Teacher/Educator/Professor/Mentor Other (please specify) Question Title * Date of Loss(es):(Example: January 1, 2000) Question Title * Names of any additional people in group you are also RSVPing for:(Please include their relationship to the individual you have lost. Also please provide their email address so we can send them an event reminder.) No Yes. Please list their name(s), email address(es), and relationship to the loss. Question Title * Have you attended AFSP's International Survivor of Suicide Day Event before? Yes, In Person Yes, online No Question Title * What is your level of AFSP involvement:(Please mark all that apply) This is the first AFSP event I will be attending I have attended an AFSP event before I am interested in volunteering for AFSP I have walked in an Out of the Darkness Community or Campus Walk in Illinois I have donated to support an Out of the Darkness Community or Campus Walk in Illinois I currently (or in the past) volunteered for AFSP I would like to receive the monthly AFSP Illinois enewsletter I currently receive the monthly AFSP Illinois enewsletter Other (please specify) Question Title * How did you hear about this event? AFSP Newsletter (Sent by Email) AFSP Website Facebook AFSP Page Hospital Referral LOSS Newsletter Mental Health Professional Referral Newspaper Out of the Darkness Community Walk PSA on Radio Referred by Friend Search Engine Support Group Referral TV Coverage Twitter (@AFSPIL @AFSPChicago or @AFSPNational) Other (please specify) Question Title * Are you a mental health professional? Yes No Other (please specify) Question Title * Is there any additional information you would like us to have? Done