Still We Rise: Participant Info
HELLO and WELCOME! I’m grateful you're planning to join us on July 25, 2019 for Still We Rise, a one-night, online sharing-and-support session, created exclusively for divorced, divorcing and/or separated women who are also actively working as specialists within the field of sex addiction and/or betrayal trauma.

On July 25, our agenda will be simple: We’ll come together to create a space that is healing, safe and courageous. We’ll exchange personal stories without judgment or criticism, and we’ll rally behind one another in coming to terms with the loss of our beloved partners and relationships.

To ensure an environment of mutual safety, all participants MUST (a) provide the following participant information, (b) agree to honor group privacy, confidentiality, sensitivity and self-care policies, and (c) acknowledge your own self-responsibility disclaimer.

Please note that the details you provide here are for my (Gaelyn's) eyes ONLY. During the group session, you are welcome to share or withhold any specifics you wish about your situation; you may also use a pseudonym for anonymity, if you prefer.

If you have any questions about this form, its purpose or its application, please reach out to me by email:

In service and support,

Gaelyn Emerson
My full name is: *
My email address is: *
My cell phone number is: *
My website (if applicable) is: *
May Gaelyn contact me via text message or voicemail, using the number provided above? *
During the group session, I plan to use the following name or pseudonym: *
Where or from whom did I learn about this group? *
Please share a little bit about my personal situation; specifically, what circumstances prompted me to request an invite for this specific sharing-and-support opportunity? *
Please share a little bit about my professional situation; specifically, what kind of work I do, and in what capacity? Please also include my professional credentials. *
Never submit passwords through Google Forms.
This form was created inside of Women Ever After. Report Abuse