Eye of the Survivor Workshop & Retreat 
United Suicide Survivors International is pleased to partner with organizations and events to bring the Eye of the Survivor Workshop & Retreat to local communities. To begin the process, please complete the following form. 
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ORGANIZATION & EVENT DETAILS
Which of the following best describes your current relationship with United Survivors regarding this event? (Please note, if you haven't already met with a US representative, we will follow up with you within 1-2 weeks to provide a check list for getting started. The date(s) selected may need further review depending on trainer availability.) *
What is the name of the Organization or Event hosting the Eye of the Survivor Workshop & Retreat?  *
What is the name and address of the venue where you would like to host the Eye of the Survivor Workshop & Retreat?  *
What is the desired date of the Eye of the Survivor Workshop & Retreat? *
What is the website of the Organization or Event hosting the Eye of the Survivor Workshop & Retreat?  *
Will this Eye of the Survivor Workshop & Retreat be Open or Closed? *
PRIMARY CONTACT & AUTHORIZED SIGNER DETAILS
Primary Contact Name *
Primary Contact Title *
Primary Contact Phone Number *
Primary Contact Email Address *
Authorized Signer Name, Title, Phone Number and Email Address if Different From Primary Contact. If this is the same, please type N/A. *
What is the billing address of the Organization or Event hosting the Eye of the Survivor Workshop & Retreat?  *
PARTNER AGREEMENT

OPTIONAL Some organizations and event hosts secure a professional photographer or videographer to record participant stories following the Eye of the Survivor Workshop and Retreat. These videos can be used by the participant and/or the organization. Host organizations should be sure to have proper waivers and releases in place to describe permissions for any use of the videos. In addition, some organizations host a follow up event – such as a panel presentation – that allows participants to share their stories with a local audience or community. If your organization plans to incorporate a videographer or host a follow up event, Eye of the Survivor Trainers can provide up to 1 hour of coaching and recommendations as part of this agreement. 

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To complete the process, please check the mark below and click submit. We will contact you withing 1-2 weeks to confirm your interest, details, invoice and registration process. *
A copy of your responses will be emailed to the address you provided.
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