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Bereavement Spiritual Support Group registration form – Summer 2020 San Francisco

Tuesday evenings (6:30-8:30pm), June 23 through August 11, 2020
at Congregation Sha'ar Zahav
in San Francisco,
or on Zoom
Registrant*
First name Last name
Contact Information
Name*
First Name Last Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Phone **
Day Phone
Cell Phone
Email*
Name(s) of Loss(es), and Relationship(s) to you*
(Example: Rachel, my mother)
Payment
When registering, you may pay a $25 non-refundable deposit or the full cost.

We understand financial challenges in the face of grief and ask you to please call us if you need scholarship or other financial arrangements. No one is turned away for lack of funds. 415-750-3436.

This spiritual support group is made possible, in part, by the gracious tzedakah of the Jewish Community Federation and Endowment Fund. We thank them for their kindness and understanding of spiritual support in the terrain of grief.
Select payment option*
- Full Payment
- Minimum Deposit
The full amount or, at minimum a $25 deposit, is due at time of registration.

We accept online payments through VISA and MasterCard; please call us if you prefer another payment method.

To arrange for a scholarship or payment plan, please contact Bay Area Jewish Healing Center at 415-750-3436.
Payment amount
Price: $150.00 Quantity:
Deposit
Price: $25.00 Quantity:
Optional contribution to help sustain Bay Are Jewish Healing Center's grief support programs
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Note: This group may be offered through Zoom, or through a combination of remote and in-person participation (to be determined closer to the June 23rd starting date).
Please indicate:*
- I am registering for either Zoom or in-person
- I would only join if group is in-person
- I would only join if group is on Zoom
Note: To secure a place in the group, please contact us or complete the registration form by June 9, 2020. Registrations received after that date (or after enrollment is full) will be placed on our waiting list.

Once we receive your registration, we will contact you to arrange an intake conversation via Zoom.

First name	Last name

Bereavement Spiritual Support Group registration form – Summer 2020 San Francisco

Contact Information

Payment