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Sign up for From Self-Care to We-Care

This is the online registration form for From Self-Care to We-Care: Compassion Practices for Individual AND Collective Resilience. If you have any trouble completing this form online, feel free to contact us and we can register you by email or over the phone.

"*" indicates required fields

Name*

First Last

Email*

Where do you live on the planet?

State / Province / Region Country

What is your time zone?*

Generally speaking, when would you be available for the weekly one hour small group practice sessions (check all that apply)?

As part of the course, you will be in a cohort group where, each week, you will meet to practice the collective practices introduced during the live sessions.

Weekday early mornings before 8am

Weekday mornings between 8am and noon

Weekday afternoons before 5pm

Weekday evenings between 5pm and 8pm

Weeknights after 8pm

Weekend early mornings before 8am

Weekend mornings between 8am and noon

Weekend afternoons before 5pm

Weekend evenings between 5pm and 8pm

Weekend nights after 8pm

Are you joining this course as part of a group, organization, or community?*

What is the name of your group, organization, or community?*

Are there 5 or more participants joining this course from your group, organization, or community?*

(a 77% discount is offered for groups of 5 or more participants joining from one group, organization, or community)

From Self-Care to We-Care (Cyber Monday rate for full 4-week course with all materials included))*

Price:

From Self-Care to We-Care (group rate for full 4-week course with all materials included))*

Price:

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What form of payment would you like to use?*

Credit Card/ Paypal processing fee

$0.00

Total (USD)

Credit Card*

Card Details

Cardholder Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Paypal Payment Method*

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Are there any particular questions or topics you'd like to explore in the course?

Do you have any other requests for Jesse, the facilitator?

Email

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