What is your name? *

First Name

Last Name

What is the best number to reach you? *

Country

(###)

###

####

Please select all that apply to you in terms of race and ethnicity. *

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

Hispanic or Latino

Middle Eastern or North African

Multiracial

South Asian

White

Some other race or ethnicity (please specify below)

Decline to answer

Do you have any access requirements you'd like us to be aware of? *

We do our best to be inclusive of everyone in our programs. There may be times when retreats are not fully ADA-compliant in terms of where the retreat is held, how the room furniture is arranged, and how the meeting information is planned to be communicated. If you have any access requirements, please let us know so we can work on the best placement and arrangements for you.

Yes

No

Decline to state

I confirm I have read and watched the materials you shared. *

Yes, I have!

I confirm I am available to attend the retreat April 18-21, and the group sessions via Zoom 9-11am PT on May 2, June 6, July 3, Aug 1, Sept 5 and Oct 3, 2024.

Yes, I'm available for both the retreat and the group sessions.