Music As Medicine Work That Reconnects Workshop Application Form
Thank you for your interest in the Music As Medicine Work that Reconnects Workshops. Your information will be treated confidentially, we are only gathering your personal details for the purpose of your application.
What is your full name?
What is your contact number?
Which workshop are you applying for?
Saturday Only (open to all, to experience The Work that Reconnects with community singing
Sunday Training for Trainers Only (open to facilitators/educators primarily)
What is your gender?
Prefer not to say
What is your age group?
61 or over
Prefer not to say
What would you like to get out of the workshop(s)?
Can you tell us a bit about your background in relation to climate & other activism, volunteerism, community work etc.?
If you are applying for the Sunday 28th July workshop for facilitators, can you tell us about your facilitation work?
Please tell us about any community or group singing experience you may have had in the past?
Would a lack of childcare be a barrier to you participating in this workshop?
Please feel free to elaborate:
Do you have particular needs which would influence your participation? (e.g. learning, mobility, dietary)
Which pricing would you chose if you get a place?
Standard: €50 one day/€90 both days
Pay It Forward: €65 one day/€115 both days (This payment helps us to offer spaces to those who cannot pay the full amount)
Concessions: €35 one day/€60 both days (For those in receipt of a welfare payment or on low income)
Bursary: €0 (I can't pay but would love to come anyway)
What local/global issues are you most concerned with at the moment?
Sustainability and environmental issue in general
Biodiversity Loss, mass extinction
Rise of extreme right, treatment of minorities
Economic poverty and inequality
Health, physical and mental
Mainly local and Irish issues
Mainly global issues
I see global and local issues as interconnected
Breakdown of the EU
How do you feel you are coping with 'the state we're in' globally at the moment?
I'm aware of the issues but I'm fine, the state of the planet doesn't effect me day to day
I find that some days I find it hard, it can be overwhelming but I can still manage pretty well
I'm really overwhelmed/anxious/in despair and finding it really hard to cope
Where did you hear about the workshop?
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