Registration for Work That Reconnects Evening Workshop, Christchurch City - Friday 10 June 2022, 7-9.15pm
To complete your registration and secure your space, fill in this form and pay your contribution (account info provided in registration email reply).
Sign in to Google to save your progress. Learn more
Email *
What is your name? *
How much do you select to pay? *
Choose amount in $. Sliding scale $20-30. Your generous contribution supports me to keep offering this work. Thank you.
Where do you currently live? *
What do you most hope to get from this workshop? (select up to 3 options) *
Required
On a scale from 1-10, how intense are your feelings around what is happening on Earth? *
minimal, I feel pretty numb
very intense, I experience huge grief/anxiety/anger
On a scale from 1-10, what is your level of anxiety/fear about our current situation? *
very low
extremely high
Have you attended a Deep Ecology/WTR workshop/retreat before? *
Are you willing to take 100% self-responsibility for your mental/emotional experience during and as a result of our time together? *
The nature of this work guides us into and through deep and at times painful places. Participation in this event requires your mature capacity to take self-responsibility for your mental and emotional experience. If you have questions about this, please ask.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms