DJ's Alliance Interest Form

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By filling out this form, you agree to be subscribed to the newsletter for DJ's Alliance which is a grassroots organization connecting suicide loss survivors in Delaware to peers and community members in an effort to provide resources in the wake of a tragedy.

If you requested more information or help via this form, someone will be in contact with you soon!

Email *

Please write your First and Last name. *

Please add your email address. *

Please add your phone number. *

Please let us know which city/town and state you reside in. *

If comfortable, please provide your home and mailing address.

Which of the following category/categories do you fall under? *

Suicide loss survivor

Community resource

Professional

I support the mission of DJ's Alliance!

Other:

Required

For suicide loss survivors, please let us know who you lost by suicide.

Spouse

Significant other

Child

Sibling

Parent

Grandparent

Other family member

Friend

Co-worker

Other:

For suicide loss survivors, if you would like to share your experience, we would love to hear your story and better support you throughout this process.

Do you need help or would you like to offer help? *

I would like help for myself.

I would like help for a family member, friend, colleague or other person close to me.

I would like resources for my organization, office, etc.

I would like to help DJ's Alliance (please let us know how by checking "Other" and let us know what you have in mind!).

I would like to offer resources.

I would like to receive news about DJ's Alliance, but do not need anything else at this time.

I would to sponsor DJ's Alliance to further the work of this organization. (Please note: We are not a 501(c)3 organization yet, however, that is in the works!)

Other:

Required

If you are a professional or community resource, or would like help for your organization/office/etc., please tell us more.

If you have a newsletter or other news resource for your organization, religious group, business, etc. that we could share news or resources with, please let us know.

I understand that DJ's Alliance is not a crisis center and does not offer mental health services or legal advice. I further understand that if I am in an mental health crisis, or know someone who is, I should contact my therapist, 911 or 988 for help. *

Agreed.

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