Membership Application
I'm thrilled that you want to join our Radical Authenticity Conscious Communication Practice Circle!

Membership is on a monthly basis. You can join us for just one month or stay with us month after month for ongoing support and deepening. Financial investment is $90/month.

Please complete this form to submit your application. I'll send you an email and/or give you a call within a week.

If you have any questions, don't hesitate to reach out to me at teri@radical-hearts.com.

I look forward to connecting with you!

💕 Teri
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Email *
Email Confirmation *
It's amazing how often I mistype my email! I don't want to miss you because of that.
Name *
Phone Number *
Pronouns *
ABOUT YOU
Familiarity & Experience *
How much familiarity do you have with conscious communication frameworks (NVC, authentic relating, etc.) and/or experience in practicing it?
Total newbie
Pretty advanced
Please elaborate... *
What exposure/experience do you have? (No judgment here — just to help me better support you!)
Growth Edges *
What do you want the most support with? Pick your top 3-5 (or all of them! 😜)
Required
Additional Info
Anything else you want me to know about your experience, needs, or preferences?
CIRCLE AGREEMENTS
Participation is Key *
I understand that my collaborative, open participation and engagement is foundational to the benefit I give and receive in this practice circle.
Confidentiality is Expected *
I understand that the personal details I and others share are expected to be held confidentially and that only my own experience may be shared outside of the group.
This is Not Therapy *
I understand that while this work is therapeutic in nature, it is not psychotherapy nor a substitute for appropriate clinical care.
Oppression is Real *
I understand that all relational struggles are contextualized by one's social position within supremacy culture and that developing this awareness and understanding is part of the work of conscious communication.
Committed to Wholeness *
I am committed to recognizing and unlearning my internalized biases against marginalized voices, both internal & external, and understand this means I may receive calling-in feedback with this intention.
Financial Contribution *
I understand that there are overhead costs to running this group, and that much time, energy, and financial investment has gone into the training of the facilitator, and so am willing and able to financially contribute $90/month.
Additional Info
Anything you want me to know about your willingness and/or ability to abide by these agreements?
FINAL NOTES
What questions do you have about me or this circle?
Anything you're curious or confused about that I can clarify or elaborate on?
How did you find out about this circle? *
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