RECLAIMING

Enrollment Form

Thank you for wanting to step into this co-creative journey with me!

Please fill out the form below if you are enrolling into RECLAIMING. Visit the RECLAIMING page for specifics about program and content. Once you complete this enrollment form I will forward you an invoice for payment. I will forward more once payment is received (intake form, registration packet, etc.)

Name

First Name

Last Name

Email

Support Structure

(Which level of support you are selecting for this round o RECLAIMING)

Pricing Tier

Please visit my Justice & Equity Statement on my Work With Me page before selecting

Payment Schedule

Message

Anything else you would like to add here?