2025 Central Family Forum Registration

Request to attend

We encourage you to fill out the form below to express your interest in attending the family forum. We will be in touch soon.

If you need assistance or have questions please contact Kelley Thompson at (888) 567-9490 or [email protected].

Email(Required)

Enter Email Confirm Email

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Have you attended a Threads of Life Family Forum before?(Required)

Yes, I’ve attended a family forum before

No, this is my first time

I am registering because of a work-related:(Required)

fatality

life-altering injury

occupational disease

Name of worker affected by workplace tragedy:(Required)

Yourself or a loved one.

My relationship to the worker affected

Date of incident or diagnosis

Date of birth of worker affected

Date of death (if applicable)

Will you have any additional family members attending?

Yes

Please note: If family members reside in a separate household, we recommend they complete a separate registration.

Additional family members

Please indicate the names, ages, and relationship for any additional family members from your household. Sessions are recommended for family members 14 years of age and older, who are emotionally ready to heal, share their grief and hear others’ experiences.

Name of second family member(Required)

Please include first and last name, relationship to worker, e.g. daughter, sibling, or parent.

First Last

Second family member's email (if different)

Second family member's age and relationship to the worker

Name of third family member

Please include first and last name, relationship to worker, e.g. daughter, sibling, or parent. (if required)

First Last

Third family member's email (if different)

Third family member's age and relationship to the worker

Name of fourth family member

Please include first and last name, relationship to worker, e.g. daughter, sibling, or parent. (if required)

First Last

Fourth family member's email (if different)

Fourth family member's age and relationship to the worker