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Healing Space - Registration
Welcome! Please complete the registration form below to request a spot in our Healing Space!
Class will be held virtually, Fridays, 9:00-10:00 a.m.
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Email Address
*
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First Name
*
Your answer
Last Name
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Your answer
Phone Number
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Your answer
Address: (Home or Mailing)
*
Your answer
Birthdate
*
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Gender:
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Male
Female
Non-binary
Other:
Which of these best describes you?
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Black, African, African American
Hispanic or Latino
White or Caucasian
Native American or Alaska Native
Asian or Pacific Islander
Other:
Employment Status:
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Employed
Unemployed
Seeking Work
Other:
How did you hear about us?
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What do you hope to learn from this class?
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