Healing in Nature: Bereavement Network Group Registration
It is important to know that your responses on this form will be kept confidential and private, only members of Healing in Nature: Bereavement Network (HNBN) have access to this information and no-one else. Please contact us at info@bereavementnetwork.ca if you have any questions or concerns.

Please note: We ask that you provide us with your full name and contact information so that we can efficiently connect with you. Addresses are asked to be provided to take into account your location when planning our trails.
Email address *
First Name *
Last Name *
Preferred Name
Additional Contact Information
Phone Number *
Address *
Demographics
Gender *
Age *
Contact
When is the best time for us to contact you? *
Emergency Contact
Full Name
Relationship
Phone Number
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