Become a Supporting Organization

National Physician Suicide Awareness Day Supporting Organization Form

Complete the following form to be a supporting organization on #NPSADay and beyond.

Contact Name(Required)

First

Email(Required)

Organization Name(Required)

Organization Website(Required)

Organization City(Required)

Organization State(Required)

Organization Country(Required)

Describe how your organization plans to recognize National Physician Suicide Awareness Day.(Required)

Upload a high-resolution logo with transparent background.

Upload a high-resolution logo with transparent background.(Required)

I confirm our organization’s commitment to help prevent physician suicide on this day at our organization’s discretion.(Required)

I confirm our organization’s commitment to help prevent physician suicide on this day at our organization’s discretion.

By confirming, your organization agrees 1. To raise awareness of physician suicide and promote resources to help prevent physician suicide; and 2. To allow your name and/or logo to be featured in all National Physician Suicide Awareness Day promotional materials.

Share more information about what your organization is doing on #NPSADay (e.g., images, programming) with us at PFMedia@jpa.com.

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This website is intended for awareness-building and informational purposes only. If you or someone you know is struggling or in crisis, call or text 988 or chat 988lifeline.org.