Register for Suicide Survivors Camp

First Name

Last Name

Date of Birth

Email Address

Phone Number

Have you been affected by suicide? Have you been affected by suicide?YesNoUnsure

Is this your first LAL Event? Is this your first LAL Event?YesNoUnsure

Would you like to be a part of future LAL events? Would you like to be a part of future LAL events?YesNo

How did you hear about us?