Survivor Day Event Application Form

Where would you like to organize a Survivor Day 2017 event?

If not yet determined, please provide as much information as possible, e.g., Monmouth County, Southwest Arkansas, etc.

If not yet known, please provide an approximate zip/postal code.

Check all that apply.

I.e., are you active with your local AFSP chapter?

Please provide first name, last name, position (e.g., fellow volunteer, chapter board member, AFSP staff person).

Even if you're not an AFSP volunteer, you may find opportunities to collaborate with your local chapter or enlist their help with hosting a Survivor Day event in your area.

Check all that apply.

Name * Website
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Organizing a Survivor Day event on your own can be quite challenging and time-consuming. Please refer to the Step-by-Step Organizer's Guide, the Monthly Planning Calendar, and the Promotion & Publicity Toolkit for details. We strongly encourage you to find an organization (AFSP or other) that can help you by offering volunteer support, resources, and event planning know-how.

If you have questions about any of the points below, please contact Inge De Taeye, Loss & Healing Programs Manager, at [email protected].



As a Survivor Day Organizer, I agree:

1. To host a Survivor Day event on Saturday, November 18, 2017.

2. To carefully review the planning materials on afsp.org/SurvivorDayResources, especially the Step-by-Step Organizer’s Guide, the Promotion & Publicity Toolkit, and the Guide for Breakout Group Facilitators.

3. To designate a core event planning team, consisting of myself, the Organizer (i.e., the main coordinator and contact for my event); a Co-Organizer; and a social media–savvy Promotion & Publicity Chair.

4. To develop a robust event program for suicide loss survivors (using the Step-by-Step Organizer’s Guide as inspiration). I understand that my event must include a screening of the film The Journey: A Story of Healing and Hope as well as its follow-up featurette (together referred to henceforth as the “Survivor Day documentary”), which AFSP will provide on DVD or digitally, and that breakout sessions are highly recommended. I will screen the aforementioned Survivor Day documentary in its entirety (45 minutes total).

5. Not to show the Survivor Day documentary in public prior to my Survivor Day event, nor will I edit, alter, or change the film’s content in any way. [AFSP note: You may, however, show the Survivor Day documentary privately to the people who will act as discussion moderators or breakout group facilitators at your event to familiarize them with the material.]

6. To display a selection of AFSP resource materials and additional local resources at my event.

7. To encourage attendees to complete event evaluation forms, which AFSP will post on the afsp.org/SurvivorDay website.

8. To refrain from using and/or sharing any contact information collected from my event participants other than for the express purpose of providing resources for suicide loss survivors.

9. Not to use the event as a fundraiser.

Additional requirements for organizers whose events are (co-)sponsored by an AFSP chapter or community walk:

10. To collaborate with my local AFSP chapter, community walk, and/or field staff throughout the event planning process.

11. To respond to all email/phone communications and requests from AFSP staff, chapters, and event registrants within 3 business days.

12. To get prior approval from my local AFSP chapter or community walk before incurring any expenses related to my Survivor Day event for which I expect to be reimbursed.

13. To refrain from using and/or sharing any contact information provided by my event participants for anything other than AFSP-related business.

I.e., your event's main coordinator and AFSP contact.

Please double-check that the email is correct.

Please double-check that the email is correct.

Please double-check that the email is correct.

If your event application is accepted, we will create a webpage for your event on the AFSP website where you’ll be able to post information about the event (e.g., address, parking info, time). On that same webpage, people will also be able to sign up to attend your event by filling out a registration form that captures their name, loss information, special needs, etc.

To help us customize the attendee registration form to suit your needs, please consider the following questions:

The focus of Survivor Day should be on the needs of suicide loss survivors. For that reason, some event hosts allow only people who have lost someone to suicide to attend. Other hosts also welcome non-loss survivors at their events (e.g., friends of the loss survivor, mental health professionals interested in learning about suicide loss).

This year’s Survivor Day documentary film will be available in both DVD format and downloadable digital format.

Survivor Day event organizers will be able to download the digital version of the film on our website. Digital format offers the best (high definition) picture quality. The digital film version can be screened directly from a computer.

The DVD format is standard definition. DVDs will be mailed to organizers and can be screened from a DVD player.