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Services Request Form
We are thankful for your desire to use our services for your group. We ask that you make your request at least 3 months in advance.

Members of our team can be available to speak at conferences, and/or provide trainings and events on a variety of topics related to member care and the challenges facing cross-cultural workers. Our services include, but are not limited to debriefing, counselling, spiritual formation, workshops and events. Please make your request at least 3 months in advance.

Please note that The Well provides a variety of events for the community. These can be found on the "events page".

What kind of service are you looking for? *
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Please provide details on how you envision The Well being involved in your event. *
Your answer
What topics would you like The Well staff to cover? *
Required
How many attendees do you anticipate? *
Your answer
How long will the sessions (that The Well is involved in) be? *
Your answer
What are the proposed dates of this event? *
Your answer
Where will this event take place? If in Chiang Mai, please provide the name of the venue. *
Your answer
What is the name of your organization? *
Your answer
Please Tell us a little bit about your organization/group. *
Your answer
Who is the contact person for this event? *
Your answer
Email address of contact person? *
Your answer
VOIP for contact person?
VOIP stands for "voice over internet protocol" such as skype, vsee, zoom, etc.
Your answer
Phone number of contact person? *
Your answer
Any other information that we need to know?
Your answer
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