Filipinx Food as Medicine - Healing with Autumn Transitions Registration Form

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Please thoroughly read all the info at https://www.kaidelgadopfeifer.com/foodmedicineautumn2023

before filling out this entire form. Detailed info is not contained here-- please go to the link above.

Registration and full reciprocity contribution (or agreement about scholarship or alternative exchange) must be complete to hold your space in the course.
Once you have submitted this form, I will email confirmation and payment info within 7 days of submitting. Please be patient on my response as I do not have steady internet access in August.

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Filipinx Food as Medicine - Healing with Autumn Transitions

Sundays September 3, September 10, September 17, September 24, & October 1 | 1-4pm PT | 4-7pm ET

Taught by Kai Delgado-Pfeifer | IG @lolas.apo

Registration Closes Sunday August 27, 2023

Email *

Did you read all the course information at https://www.kaidelgadopfeifer.com/foodmedicinesummer2023 ?
*

Yes

No (If no, please read the detailed course info before filling out this form)

Name *

Phone Number

What is your Racial/ethnic/cultural background? A kind reminder that this space is for BIPOC & mixed race folks (including from European descent lineage). We gently ask our kin who come only from european descent lineage to find other spaces to deepen into your healing of self, community, & earth. *

Gender Pronouns. If this is unfamiliar to you, we encourage you to read more here: https://www.npr.org/2021/06/02/996319297/gender-identity-pronouns-expression-guide-lgbtq *

What calls you to Gather with our circle? What are your learning intentions? Please offer at least 3 sentences here to help us understand clearly why you're arriving. *

What is your background, if any, in food, herbalism, ancestral healing, environmental/ecological work, or movement building/community organizing? It's ok if this course is a starting point-- we welcome all. *

Due to the intimate nature and overall learning arc of our journey, participants must be able to attend at least 4 out of 5 sessions (with our first session being required) and remain present for the majority of gathering time.

Will you be able to meet this request? If no, we kindly ask that you register for our email list so you can get plugged in for future offerings that you can be fully present for. Sign up at www.kaidelgadopfeifer.com/stay-connected

Yes

Do you have any allergies or dietary restrictions I should be aware of when preparing our recipes/cooking lists?

Which reciprocity contribution scale will you be offering? If you would like to offer within the scale above $150 or under $400 USD, you are welcome to do so by selecting “Other” and inputting your desired scale. If you are applying for a scholarship or need a payment plan please read the directions carefully. *

$150 - This supports the program cost for self.

$275 - This supports full program cost for self & partial contribution for a fellow community member.

$400 - This supports full program cost for self & full contribution for a fellow community member.

$150-400 Sliding Scale but I need to work out a Payment Plan ***Please fill out this entire form and email me at lolasapofood@gmail.com with your payment plan request. Full exchange must be received by the 2nd class on September 10***

Scholarship/Free Participation Application *****Please fill out this entire form and send your request via email at lolasapofood@gmail.com if you would like to be considered for a scholarship. I will follow up with more detailed questions in response.***** Please note that these spaces are prioritized for folks from working class communities (earning around $25k/year or less and/or qualify for programs such as Medicaid/Food Stamps). If you do not fall within this group, we ask you to consider requesting a payment plan for the lowest sliding scale.

Other:

Any other Questions or Concerns? Please email lolasapofood@gmail.com if you are in need of the community builder scale -- we will work to make your presence possible regardless of ability to contribute monetarily.

Send me a copy of my responses.

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