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?
Yes   No   
Other Comments






At any time, if you would like to be removed from mailing list/member list, please send an email to: tcfrva@hotmail.com and put "Remove" in the subject line.
 

 

Copyright 2016 by The Compassionate Friends RVA