Healers & Helpers Event Registration
Healers & Helpers: A Therapy Speed Meeting Event
Date: Sunday, July 21, 2019
Time: 1PM-4 PM
Location: The Rotunda, 4014 Walnut Street, Philadelphia, PA 19104

This registration form is for both participants and Healers/Helpers.

Healers and Helpers - We consider 'healers and helpers' to be anyone who is trained to respond to trauma, crisis, or the life management of others within the Healing Justice Framework. This may include but is not limited to therapists, psychologists, psychiatrists, marriage and family counselors, doulas,, life coaches, alternative/natural/holistic healers, sex therapists, and social workers. These practitioners must also be Black women or femme.

Notes:
Please understand that this event is not an actual therapy session; it is an opportunity to connect with a Healer or Helper from whom you would like to seek support/therapy.
The event is free, but limited spots are available so you must RSVP.
The Rotunda is an ADA accessible location.
Childcare will be provided.
Light refreshments will be provided (please RSVP for accurate catering).
If you are unable to register online, have questions, or need additional accommodations, please call or text 267-606-0992.
You can also reach us by email: WomanistWorkingCollective@gmail.com

Please answer carefully and to the best of your ability.

Email address *
Name *
Your answer
Phone Number *
Your answer
Are you a Womanist Working Collective Member? *
You do not have to be a WWC Member to attend this event. This question is for tracking our membership participation only.
Required
Do you self-identify as Black? *
Everyone must answer.
Do you identify as a woman (cis woman/trans woman/womyn/womxn), femme or non-binary person? *
Everyone must answer.
How are you showing up at this event? *
Everyone must answer.
How will you compensate your Helper or Healer (at future sessions, not at this networking event)? *
Participants must answer.
If you plan to pay this Healer/Helper through your insurance, please share the name of your insurance carrier. This will help us to invite someone who may take your insurance.
Your answer
What kind of support are you seeking?
Participants must answer.
What kind of Healer or Helper are you?
Healers & Helpers must answer. Participants do not answer.
How are you able to be compensated for your services?
Healers & Helpers must answer. Participants do not answer.
If you as a Healer/Helper accept insurance, please list the insurance carriers that you accept:
Your answer
For participants: In which specialty areas would you like your Helper or Healer to have experience? For Helpers & Healers: Please select all with which you have experience. *
Everyone must answer.
Required
Will you need childcare for this event? *
Everyone must answer.
..What did we miss? Include your notes and additional accommodations below. You can also call us to discuss additional accommodations: 267-606-0992
Your answer
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