Radical Listening, Radical Love
Registration Form - Fall 2016 Workshop
Location: Sfeer Studio, rural Chapel Hill, NC

Dates: Friday November 11th -Sunday November 13th

Friday 6-9pm
Saturday 10:00am – 6:00pm, potluck lunch
Sunday 10:00am – 3:00pm, lunch provided

Follow-up day: Sunday January 22nd, 10-3pm

Optional Meet-up: Saturday, December 17th
10:30 – 12pm Free yoga class with Patty at Durham Yoga Company
12:30 – 2:30 Potluck meet-up and community-building at a nearby location

Thank you for your interest in exploring trauma-informed yoga and the critical roles of self- and community-care in justice work. We, Michelle and Patty, are grateful and excited to be sharing in this work with you!

To assist us in preparing for the glorious mix of folks who will be present, please fill out as much of this form as you feel comfortable to and able to. It should only take a few minutes, and your answers will help us optimize the experience.
What is your name? *
How would you like to be called in the space? Include First and Last Names, please, along with other names that might be helpful for us to have. (For example, if the name you give us here is different than the one that appears on the accounts you will use to make payments, or your email address, please indicate that).
Your answer
Yoga Background
What is your level of experience with the physical practice of yoga (asana)? *
Please describe your level of experience with other aspects of yoga: study of yoguic texts, meditation practice, karma/seva (yoga service), etc. *
Your answer
Preparing for this workshop + The work
What is your experience with working at the intersection of yoga, trauma healing, and social justice? *
Please just tell us a little bit about what, if any, exploration you have previously done around the intersections of yoga and social justice work. Have you attended a workshop like this before? Are you curious but new to this? Have you led workshops on these topics? Etc.
Your answer
What interests or excites you about this workshop? This work? *
Why are you drawn to attend this workshop? What draws you to working at the intersections of yoga, trauma healing, and social justice?
Your answer
What makes you apprehensive or nervous about this workshop? This work? *
What feels challenging for you about this workshop? Or this work? What does working at the intersections of yoga, trauma healing, and social justice bring up for you in terms of fears, worries, potential for being triggered/activated?
Your answer
What are you hoping to get out of your experience at Radical Listening, Radical Love? *
Your answer
More about you!
Please tell us about your racial identity.
We believe it is crucial to create spaces which mirror the larger world in their intersectional and diverse compositions. As such, we are interested in knowing about your racial identity, if you are willing to tell us about it, because it will help us be more intentional in cultivating the cohort of individuals who will be sharing this journey together.
Your answer
Please tell us about how you identify.
We are interested in knowing a bit about the composition of the group we are convening. If you're willing, tell us how you identify in terms of any/all of the following: gender identity, sexual orientation, ability, state of illness/wellness, formally/informally educated, survivor identity, documentation status, class/class background, languages spoken, state/region/country of origin, neurocognitive spectrum, rural/urban dweller, religious affiliation, everything else you would like us to know about how you move in the world. You can absolutely skip this question, or only offer what feels safe or comfortable at this stage.
Your answer
We expect that this workshop will be a loving and supportive space for folks to dig deeply into aspects of our intersectional identities--what brings us to this work as well as what we bring to this work. *
As such, it will bring stuff up. To that end, we want to know what kind of practices and support systems you may already have in place to resource you during and after the experience. Please tell us a bit about what resilience resources you have in place to support you in this work. Check all that apply.
Required
Payment Details
The sliding scale tuition for this workshop is $250 - 375, which includes 23.5 hours of content + two healthy meals and an additional yoga class. Please read the notes below, then indicate your total expected tuition amount and timeline for payment. *
We are asking for a $25-50 deposit to hold your spot, which is partially-refundable*. We are also asking for full payment by Friday, November 4th at 5pm. *If you need to cancel your registration and you do so by October 28th, we will issue a refund for any monies paid, minus a $10 service fee. If you cancel after October 28th, we will issue a refund for total monies paid, minus the amount of your deposit. In the space below, please indicate your total expected tuition amount, and if you will be able to complete payment by Friday, November 4th at 5pm. If not, indicate the proposed payment plan/timeline you are requesting.
Your answer
Based on the response we've received, we may get a lot of interest in this workshop and plan to utilize a wait-list. As such, we are asking folks to let us know as soon as possible if they have to cancel, and/or to pay full tuition by Friday November 4th at 5pm so that we can maximize everyone's opportunity to participate. *
The purpose of this question is confirm your commitment that, in the event of a need to cancel, you will let us know as soon as possible but no later than Friday, November 4th at 5pm. You also understand that if you cancel by October 28th, you will receive a tuition refund equal to the amount you have paid minus a $10 service fee; and if you cancel after October 28th, you will receive a refund for total monies paid, minus the amount of your deposit.
Registration for this workshop implies your commitment to be present at each of the required modules, including all three days of Part 1, Fri Nov 11 - Sun Nov 13, AND Part 2, Sun Jan 22. *
Attendance at the optional intermediate meet-up day (Saturday Dec 17) is optional but strongly encouraged. Please indicate that you are prepared to attend all parts of both sessions. We understand that things come up last minute and of course we will be flexible with that. At this stage, however, we will only confirm registration for those who can commit to attending all parts, all days, all sessions.
Deposit info: Please tell us how much you will be depositing ($25-50) to hold your spot, and how you will be paying it: Credit Card, Paypal, or check. *
For example: "$50, Paypal" or "$35, Credit Card." We will send you payment instructions once your registration is complete.
Your answer
What is your email? *
We need this to communicate with you. We will not share this with anyone. If you don't use email, it will be harder for us to communicate with you but we'll work to accommodate this. If you cannot/do not use email, leave us your phone number.
Your answer
Anything else you'd like us to know? *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy