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Workshop Participant Questionnaire 2017
This questionnaire is confidential and will not be shared with the other participants. Please do not answer any questions that you do not feel comfortable with. We want to get to know you prior to the event! Help us make this gathering special.
Email address *
Moving from #resist to #transform workshop October 6, 2017
Personal Information
First and Last Name *
Your answer
Mailing Address *
Street, City, State, Zip Code
Your answer
Telephone Number *
Your answer
Email Address *
Your answer
Date of Birth (DOB)
Your answer
Participant Survey
The following are open ended questions intended to help us get to know you and to understand your personal and professional aspirations and thoughts on the workshop topic.
What are the personal challenges you deal with on a daily or weekly basis?
Your answer
What can you imagine yourself doing five years from now if there were no constraints on your life (geographic, relationship, financial, etc.)?
Your answer
I have a network that I trust to support me.
#Resist
What does #resist mean to you?
Your answer
What stands out to you about this moment in history regarding the rise of the #resist movement? Why/how is this significant to you?
Your answer
Please watch the video on "Unpacking Words: Resist" - consider the concept of #resist on an intimate, personal level - what is your relationship to resistance in your own life?
Your answer
What would be possible if we could move to #transform?
Your answer
Do you have any questions, concerns or comments that you would like to express to the organizers prior to this event?
Your answer
Is there anything else we can do to make you comfortable on this day? For example, do you need childcare or have any special needs?
Your answer
Are you planning to apply for a scholarship? If not, you can pay here: https://www.paypal.me/MoxieLab/30
If so, in what ways would you be willing to contribute to the event? (examples: make phone calls, help set up/clean up, be a scribe/notetaker, etc)
Your answer
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