The Compassionate Friends RVA - Sign-up or Update Your Info

New or Updated Member Information Form

We like to periodically update our membership and mailing list. Please complete the form below to ensure that we have your most up-to-date information.

This information is used for The Compassionate Friends RVA chapter business and event notification only. It is never shared or made public. Feel free to contact us at tcfrva@hotmail.com if you have questions.

Today's Date

Member Information
Your First Name
Your Last Name
Email

Address
Street Address
Address 2
City
State
Zip Code

Lost Loved One*
First Name (or Nick Name)
Last Name
Gender
Age at Death
Birth Month
Birth Day

Month of Death
Day of Death

Cause of Death (optional)
My relationship to lost loved one

Child's Other Parents
Other Parent - First Name (optional)
Other Parent - Last Name (optional)

If you have remarried (optional):
New Spouse or Partner - First Name
New Spouse or Partner - Last Name

Newsletter Sign-up
Do you want to receive our newsletter?	Yes No
May we include your child in the Children Remembered list? (for security, we do NOT ask for or list year)	Yes No
Other Comments