Wellbeing Workshops: Registration Form
Part of Care for Creatives at Southern Rep Theatre in partnership with the New Orleans Musicians' Clinic
Please choose the workshop you'd like to attend (some workshops repeat - please take care to select the correct dates): *
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
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Age (please note: you must be 18 or over to participate) *
Your answer
Email Address *
Your answer
Mailing Address (Street, City, State Zip Code) *
Your answer
Phone Number (504-555-5555) *
Your answer
Please briefly describe your reason for wanting to participate in this Wellbeing Workshop *
Your answer
Please briefly share about your current creative pursuits or interests. How do you identify as a creative? *
Your answer
On a scale of 1 to 10, how comfortable do you feel about embarking upon this new experience? *
Totally out of my comfort zone!
Way comfortable, this is my jam!
Emergency Contact 1: (Name and Phone Number) *
Your answer
Emergency Contact 2: (Name and Phone Number) *
Your answer
Do you have any mobility issues or mobility needs? *
Your answer
Do you have any special needs that you'd like us to know about? (Optional: this is to help us best serve you.)
Your answer
PAYMENT: To complete registration, please contact the box office to arrange payment. Reminder, each workshop costs $5 per session - total of $25-$30 per series, pending duration. The box office can be reached via phone: 504-522-6545 or email boxoffice@southernrep.com. *
COMMITMENT PLEDGE: Wellbeing Workshops are a group experience and work best when members attend sessions weekly. If you register for a workshop, we commit to reserving that space just for you. In return, we ask that you commit to attending the full 5-6 sessions and to please let us know in advance if you will be missing anything. Please let us know which option best describes you: *
Promo code (optional)
Your answer
Remaining questions or comments (optional)
Your answer
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