Attendee Interest Form
A Community of Hope – the 2019 National LOSS Team Conference will be held on October 8 & 9, 2019, in Visalia, CA.

It is foreseen that registration will be $200 with additional fees for continuing education units.

Registration is currently not available for this event; however, we would like to establish an early interest list to communicate with those who would like to be notified when our registration portal is opened. Completing this form establishes no commitment to attend. We will simply utilize your contact information to reach out to you and notify you that event registration is available.

Your name
Please include any titles or honorifics linked with your name.
Your answer
Your email
Your answer
Your phone number
Your answer
Please specify what type of line the phone is.
Mailing address
Your answer
We intend to offer a broad array of educational opportunities but would like to learn more about what you are most interested in. Please rank your interest in the eight conference tracks we are planning to offer.
Top choice
2nd choice
3rd choice
4th choice
5th choice
6th choice
7th choice
8th choice
New or existing LOSS Teams
Survivors of suicide loss
Suicide attempt survivors or lived experience
Family members & other supporters
First responders, law enforcement, fire, EMS, Veterans, and active military
Education and schools
Healing & self care
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