Sexy Mama Immersion Program Registration Form
Thank you for taking the next step in your evolution as a boldly embodied mama! Please fill out this questionnaire and return to Juliana. She will be in touch to set up a brief phone interview
Name *
Your answer
Email address *
Your answer
Where do you live?
Your answer
Phone *
Your answer
What drew you to the Sexy Mama Immersion Program? *
Your answer
What do you hope to come away with from this program? *
Your answer
How have you explored the theme of sexuality in your life so far? (Ex: workshops, private sessions, books.) *
Your answer
How have you explored topics around mothering in your life so far? (Ex: Parenting classes, books, groups, workshops, relatives.)
Your answer
Who or what are your main pillars of support in your life? (Ex: relatives, therapist, spiritual community or practice, partner.) *
Your answer
Is there anything else you would like me to know about you?
Your answer
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