Name *

First Name

Last Name

What date did you attend? *

9/9/19

10/14/19

11/11/19

Do you plan to attend again?

Yes

Yes, and I'll bring a friend

No

Maybe

How frequently would you like Grief Cafe to meet?

Weekly

Bi-weekly (every other week)

Monthly

What kind of theme do you prefer for Grief Cafe?

check as many boxes as you like

No theme - all grief topics welcome

Death-related grief

Parenting-related grief

Divorce/Breakup-related grief

Theme Optional - a suggested theme, but all grief topics welcome