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Enquiry

Mandatory field I...* am a bereaved person inquire bereaved persons on behalf offer grief counseling / work in palliative care Who or what are you looking for here - what do you desire… [you can also add and revise continuously after registration]

Mandatory field First name*

Mandatory field Last name*

Mandatory field Street*

Mandatory field Postal code*

Mandatory field City*

Country

Phone number

Cell phone number

Mandatory field E-mail address*

Mandatory field Password*

Mandatory field Confirmation*

The deceased was my…

Death: month and year

profile photo (we ask you to do this, it makes communication more personal)

Who are you, what do you do for/ in life, hobbies… (you can also add and revise continuously after registration)

How do you currently feel, what is important to you, if applicable, how can you live with your grief… (you can also add and revise continuously after registration)

Who or what are you looking for here - what do you want for yourself… (you can also add and revise continuously after registration)

Mandatory field privacy policy* I accept privacy policy

Mandatory field general terms and conditions* I accept the terms and conditions

Mandatory field I hereby assure that…* I am a relative/survivor in a similar situation as Ulf Leonhard I have created this profile on behalf of a bereaved person I am a grief counselor and am available for discussions with mourners.

Mandatory field Security question* Please add 9 and 9.

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