AirCraft Casualty Emotional Support Services  
A  C  C  E  S  S
AirCraft Casualty Emotional Support Services















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If you would like to have a Volunteer Grief Mentor who has survived or lost a loved one in an air crash provide you with guidance and peer support, please fill out the following information or call toll-free 877-227-6435:

All information kept strictly confidential

Name:
Address:  

City:
State:    Zip: 
Country:
Day Phone:
Eve Phone:
Fax:
Email:

History:
I survived an air crash:
I lost my (relationship):   

Name of your loved one?

Age of your loved one?

Which air carrier?
Location:      Date: 

Contact me via:
phone email

Best time for ACCESS to contact you?
How did you hear about ACCESS?
Anything else you would like to share?


A C C E S S  1202 Lexington Ave. Suite 335, NY, NY 10028  1-877-227-6435 info@accesshelp.org ©2000