Would you like to register your interest in attending a Living with Loss retreat?

Before we begin... Who and what this survey is for

This survey is intended for anyone who is bereaved, from any cause, and any length of time ago, who would like to take part in one of our Living with Loss retreats.

The author of the survey is Abi May. You can find out more about the retreats I lead here: www.avalleyjournal.co.uk

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* 1. Your name

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* 2. Email address

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* 3. About your bereavement (optional)

How long have you been bereaved?

What is your relationship to the person(s) who is deceased?

Anything else you'd like to say about your bereavement?

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* 4. What regions of the UK would you be willing to travel to for a retreat? (Eg, Southwest, Midlands, Yorkshire, etc.)

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* 5. What duration of retreat would you prefer?

Day event only

Weekend

Week (Monday-Friday)

Thank you for completing this survey.

If and when we have enough responses, we will try to organise additional Living with Loss retreats. At that time, we will get back in touch with you.

Filling in this survey is without obligation. If at any time you would rather we remove your name and email from our list, please let us know and they will be deleted. (We will not be selling or disclosing your information to anybody outside of our Living with Loss project.)

We do hope that we can give you some support in your journey through grief.

Thank you again.

Abi