Self-Compassion for Shame (6 Week Online)

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* These fields are required

1 Welcome

2 Price

3 People in your group

Guest 1		First Name* Last Name* Email* Gender
Guest 1		First Name* Last Name* Email* Gender

4 Participant Info

Preferred Title	Please include any title you would like us to use when addressing you. Examples: Dr., Rev., Sister, Brother, Father, Friar, Mr., Ms.
Suffix	Please include any name suffix or professional designation if applicable. Examples: Jr., Sr., III, PhD, MD
Phone *	Please provide your primary phone number where we can best reach you regarding your registration or retreat details.
Mobile	Please provide your mobile or cell phone number, if different from your primary phone number. This may be used for day of arrival communication or urgent updates.
Address	Please provide your mailing address. This is helpful for registration records and for mailing donation receipts or printed copies of retreat information when needed.
Address 2
City
State/Prov.
Zip/Postal
Country
Emergency Contact Info	Please provide the name and phone number of a person we can contact in case of an emergency during your stay. This should be someone not attending the retreat with you, if possible.
Program Comments or Special Needs	Please share any additional information that will help us support your stay, such as specific program requirements, electric vehicle charging needs, CPAP machine use, certified support animal(s), or any other details we should be aware of.
Birth Date *
What is your MSP (Health Care Card Number) *
Gender	We ask for gender to support respectful room assignments, inclusivity, and comfort for all guests in our ally-centred environment.
How did you hear about us?
Email newsletter	Please send me the email newsletter
Age	25 & under 26-35 36-55 56-75 76+
Cancellation Policy *	I accept the terms and conditions.Please read the terms and conditions

5 Donate

6 Security Check

7 Payment