Training Workshop Registration Form

Fill out the form to sign up for one of the upcoming Survivor Connection training workshops.

"*" indicates required fields

Name:*

First Last

Email Address:*

Phone #:*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Which Survivor Connection training workshop would you like to attend?*

What do you hope to take away from this workshop?

I'd like to become better prepared to engage with journalists and the media.

I'd like to learn self-care strategies and tips to help me cope with trauma

I'd like to learn about public health strategies and solutions that could help reduce gun violence.

I want to be part of a community and feel as though I am in a healing and safe space where I can share my experiences.

Other:

Please specify:

Do you have any dietary restrictions? Please specify below:

Is there anything else you would like us to know?

Name

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