Hibernation for Healing Registration Form

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Welcome!

We are so glad that you've chosen to join us in co-creating this journey together.

Please fill out the form below to register for the program, and share any relevant information that you'd like us to know about you. Everything you share is completely confidential and will only be read by Shawna and Liz.

Questions? Email Liz Moyer at connect@wehealforall.com or Shawna Emerick at shawnalight@gmail.com.

Name *

Email *

Preferred pronouns *

Do Wednesday Circles from 7:00 - 9:00pm ET work for you? *

Dates: Nov 18, Dec 2, Dec 16, Jan 6, Jan 20, Feb 3, Feb 17. To preserve the integrity of the community space we ask that you join at least 5 out of 7 Circles.

Yes

Mostly

Other:

Cost exchange: Please share how much you choose to reciprocate. *

Requested amount: $400. Pay-it-forward: $500. Sliding scale: $300. Your investment reciprocates Shawna's and Liz's time preparing and facilitating Circle, developing community content, recruiting likeminded participants, and creating a comfortable, generative community space. If this scale is prohibitive please contact Liz or Shawna to discuss options such as a payment plan or other creative solution. Payments can be sent via Venmo (@shawna-emerick or @liz-moyer) or email us to discuss alternatives.

Please share any accessibility or support needs you may have to participate in this program. Ex: Zoom technical support, disability accommodations, etc.

Why are you joining this program and what do you hope to receive or generate from it?

Our intention is to create a community space, program and set of practices that supports you exactly as you are. Is there anything you'd like us to know that would help us do so? For instance, recent physical or mental health challenges?

Everything you share is completely confidential and will only be read by Shawna and Liz.

Thank you!~

Questions? Email Shawna Emerick at shawnalight@gmail.com or Liz Moyer at connect@wehealforall.com.

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