Becoming Unbroken Workshop Series Registration

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Please complete the information below to register for our three-session, in-person professional development workshop. By completing this form, you are registering for all three workshop sessions. You have two registration/payment options - please review and select one. Once you submit, you will be receive payment instructions. Registration is not complete without payment confirmation. Reach out with any questions at info@distinctivesuccess.com

Email *

Full Name *

Email Address *

Mobile Phone Number

Current Professional Role/Title (if in between, please list your most recent)

Company/Organization (if in between, please list your most recent)

How did you hear about this workshop? *

Please describe your primary reason for wanting to attend this professional workshop. *

Share the top 1-2 things you hope to gain by participating in the series? *

Do you have at least one professional goal you would like to reach in the next year (or so)? *

Yes

If you answered "Yes" to having at least one professional goal, how long have you had this goal?

A few days to One month

More than one month but Less than Six months

More than Six months but Less than One year

More than One year

Clear selection

If you answered "Yes" to having at least one professional goal, what do you believe to be the greatest challenge(s) to accomplishing your goal(s)? Name any and all that come to mind.

Do you have any dietary restrictions (e.g., vegetarian, vegan, gluten-free, allergies)? *

None

Vegetarian

Vegan

Gluten-Free

Dairy-Free

Nut Allergy

Other (Please specify below)

Required

If you selected 'Other' for dietary restrictions, please specify.

Select your preferred payment option: Both options require registration for the entire three-session series. *

Pay as you go - $150 per session. Payment for the first session must be made to complete your registration. Payments for sessions 2 and 3 must be made prior to start of each session. Payments may be made online or at the door.

Pre-pay for the Series - $350 Total. Enjoy a $100 Discount when you register and pay in full. Available until December 30, 2025. Payment for the series is expected to confirm your registration at the discounted rate. Registrations not pre-paid by the due date will revert to the Pay at the Door option.

Next Steps

Upon submission of this form, you will receive an email with payment instructions. Please give it at least one full business day to arrive. If you do not see it, be sure to check your spam email box - just in case.

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