First 52 Community Contact Form
I look forward to helping you support your bereaved clients though community support discounts of the First 52 program. I just need a little information.

By completing this form, you are expressing interest in participating in the First 52 Community Support in order to improve accessibility to grief support. There is no cost for your organization to extend the reduced price benefit of this program to your community.

You commitment to the program includes:
- a link with a description on your organizations website
- communicate the reduced cost benefit with your community.

After you submit the completed form, you will receive an email address you provide with information to share with your community with the discounted link. Please check for an email from Julie@ChartreuseCenter.com Subject: First 52 Community Discount. (You may need to check a spam or junk file).

Please know your information with NOT be shared with any third-party entities.
Email address *
Type of Community Organization *
Required
Community Organization Name *
Community Organization Address (Street City, State Zip) *
Contact First & Last Name *
Contact Title *
Phone Number *
Most communication will be through Email. If necessary, when is the best time to reach you by phone? *
Required
Organization Website (enter valid website ie. https://website.com) *
I understand that there is no cost to my organization to participate in the First 52 Community Discount Program. My organization agrees to include a link on our website to the First 52, clearly display the discount code on the website, and communicate with our community our participation in the program. I understand that our community members will be receiving a 30% discount on the full price ($65) of the First 52 program and will be asked to only pay $45.50 for the full program. *
Required
Please include organization on Chartreuse Center's website and promotional materials regarding participating in First 52 Community Program. *
Required
Thank you for your interest to participate in the First 52 Community Program.
You will receive an email from Julie@ChartreuseCenter.com with the Subject: First 52 Community Discount. Please watch for the email (you may want to check your junk or spam if you do not see it within the hour.) This email will have some important information for you:
- specific designated link for the discounted code
-a couple sentences to include on your website
-an image to include on your website
-a flier to copy and handout.

If you have questions or need further information, feel free to call toll free at 800-484-5751 or email Julie@ChartreuseCenter.com
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