CSS Conference Sign Up

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in the 2nd Annual Cultivating Safe Spaces Conference. Please fill out the following form to receive your registration code. Please give us 2-3 business days to respond.

Registration Steps:

1. Fill out this form (CSS Conference Sign Up Form)

2. You will receive an email and invoice from wynette@naqsmist.com

3. Once payment is received (cheque, etransfer, bank transfer, credit card) we will send you a confirmation of your registration within 2 business days.

4. See you in June!

Your Name *

Your Email Address

Allergies/Dietary Restrictions

Please choose your age range

Under 18

18-24

25-35

36-44

45-54

55 and over

Clear selection

Organization Name

FULL address *

What brings you to this space?

Is there anything you want us to know about you?

Do you need a sign language interpreter

Yes

Clear selection

Please pick which group describes you the best

Brand new to CSS (never participated any training)

June 14th Train the Trainer Participant

Certified CSS Facilitator

First time attending the Conference

Clear selection

Which perspective group describes you best

Tradition - I like to share my lived experience as a way to contribute to decision making

Relationship - I prioritize feelings, relationships and connections in decision making

Innovation - I need time to ask questions and think before making decisions

Action - I am a linear thinker and act quickly when it comes to decision making

Clear selection

Conference Registration *

Regular Rate $1300 + GST (April 2-May 24, 2024)

Required

CSS T-Shirt $30 *

Small

XXL

No thank you

Is this a group registration?

Yes

Clear selection

How many seats?

How many people are you registering for?

IMPORTANT INFORMATION FOR ORGANIZATION AND GROUP LEADERS: We ask that your participants have some foundation of healing or have done some personal and/or professional development work. Some of the topics we cover can be challenging and push people out of their comfort zones. We will do our best to cultivate safe spaces for everyone and hope that effort will be reciprocated by all attendees.

Do you want to order T-shirts for your group?

Yes

Clear selection

Payment Option (if an organization is paying for your registration please include their name above)

Cheque

E-transfer

Bank transfer

Credit Card (can be paid through invoice)

Clear selection

I understand that my seat is not secure until payment is received. Your seat will be held for 15 days. If a message or payment is not received by then, your seat will be released. *

Yes, I understand my seat is not secure until payment is received.

I am applying for funding through my organization and require some extra time

Refund Policy:
Full refund for cancellations within 72 hours of paying. After 72 hours a $125 admin fee will be deducted from your refund. No refunds available after May 31st. Seats can be transferred to another person. *

I understand the refund policy

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Naqsmist. Report Abuse

Forms