Conscious Connecting between Men and Women: Registration Form (one per person)
Welcome! Thank you for your interest to participate.
Please fill in one registration form per person. The information is confidential and helps us create a safe space, adapted to your needs.
We limit numbers in each gathering, and try to find a rough balance between men and women if possible. We will confirm your registration within a few days. Please do honour your commitment to attend once confirmed.
Thank you!

Questions: georgina.peard@gmail.com / 079 219 4407
Email address *
First Name *
Your answer
Last Name *
Your answer
Gender *
Phone number *
Your answer
Dates you will attend *
Required
What is your motivation to attend? *
Your answer
Have you any previous experience of personal development or therapy connected to your inner masculine/feminine, relationships or sexuality? *
Your answer
Do you have any unprocessed emotional, mental, physical or sexual abuse traumas ? *
Your answer
Questions or further information to share with us
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service