Registration

 

Registration

 

Which event/course are you registering for? *

Name *

First

Last

Address *

City *

State *

Zip Code *

Email *

Phone *

We wear nametags with our fist names on them. What name do you want on your nametag? *

What pronouns do you prefer?

Will you need a ride to the event? *

• Yes
• No

Are you able to provide rides to the event?

• Yes
• No

Where will you be traveling from on the day of the event?

Are you able to stand for extended periods of time? (10-20 minutes)

• Yes
• No

Most of our activities are done on the floor in groups with back-jack chairs. Are you able to sit on the floor with a back-jack or will you need a chair for group circles and activities?

• Backjack
• Chair

Is your ability to walk restricted in any way?

• Yes
• No

How did you hear about this event?

After submitting this form you will be redirected to PayPal for payment. Enter amount in field below that you will be paying. Any payment made above the cost of the course will go into our scholarship fund. If you do not want to pay via PayPal please indicate how you wish to make payment.

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