AWOM SUPPORT GROUP E-FORM

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Welcome to AWOM Support Group registration, we are taking applicants for our next 12 week program.
Spots are very limited and require full commitment from each member. If you are not able to commit to the 12 week program, please allow others the opportunity to join and fill the seat.
We are here to provide an experience of grieving and support as a family to our members.

FULL NAME *

PHONE NUMBER *

WHO DID YOU GAIN AS AN ANGEL? HOW LONG AGO? WHAT IS THE DATE/ANNIVERSARY OF THEIR PASSING? *

WHAT DO YOU WISH TO GAIN FROM THIS SUPPORT GROUP? *

WHAT STAGE OF GRIEF ARE YOU IN? *

Shock, Denial, Disbelief

Pain and/or Guilt

Anger and/or Depression

Reconstruction and working through

Acceptance and Hope

I'm not sure

Other

CAN YOU COMMIT TO A TWELVE-WEEK SESSION? *

Yes

TELL US SOMETHING ABOUT YOURSELF

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