ICSA Workshop for Former Members Born or Raised in Cultic Groups or Environments Application for 2019 Workshop
The information you share here is confidential and will be shared only with ICSA staff and facilitators of ICSA's 2019 CT Workshop. If you are not comfortable naming your group or its leader, please indicate what type of group it was, such as religious, therapy, new age, political, eastern, etc. After we receive this form, we will contact you about registration or questions that we may have. Thank you.
Email
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Last Name
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First Name
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Address
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City
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State/Province
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Postal Code
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Country
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Cell Phone
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Other Phone
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What is your age in years?
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Type of Cultic Environment
If "other" in previous question, please describe. (300 word maximum)
Your answer
If group, what was its name?
Your answer
If group, what was the leader's name?
Your answer
If you were raised in the group, at what age in years did you enter? (Answer "0" if you were born into the group.)
Your answer
At what age did you leave the group?
Your answer
How have you been dealing with your experience (choose as many as you think apply)?
If you answered "other" to the previous question, please explain. (300 word maximum)
Your answer
If you are asking for financial aid, please tell us your reasons and how much you believe you can contribute to the event registration fee, which includes 2 nights lodging and 6 meals. (300 word maximum)
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