Copy of GriefShare Registration at HPCC

Name

Address

Cell

This address will receive a confirmation email

Date of Birth

Church you attend

Emergency Contact

How did you hear about GriefShare?

Please share a little information about the person/people you lost and when the loss occurred.

Payment Options

Pay with a Credit Card today Bring payment on next visit

Registration Fee of $20 (Includes workbook and other expenses during all 13 weeks of sessions)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Thursdays, 6:30pm, January 25th - April 19th

It hurts to lose someone.
Find help at GriefShare.
GriefShare is a friendly, caring group of people who will walk alongside you through one of life’s most difficult experiences. You don’t have to go through the grieving process alone.

Copy of GriefShare Registration at HPCC

Description

Please Fix the Following