Keeping the Well: Invitation to Spiritual Flourishing Registration

We are so glad you are here...

This is the first step of the next chapter of your spiritual journey, and I couldn't be more excited to help you carve out sacred space for yourself in this season of your life. Please use the form below to help me get to know you and your goals better.

First Name

Last Name

Email Address

Contact Phone Number

You Are Beautiful

This is why I would love to see your beautiful, shining face on our calls, and I would love to get to know you better through this questionnaire. This is a place for us to be KNOWN. We want to get to know more about you and what brought you here. This isn't a test... it's a way for us to know one another.

What 5 words best describe you?

Tell me about your spiritual journey so far...

What intrigues you the most about this opportunity?

What do you hope to gain from this experience?

What are some areas where you would like special support?

Who or what sent you?

Would you like to apply for a scholarship?

yes no

What level of Commitment feels right to you?

Amount to be charged today: $

If paying monthly, which date of the month do you wish me to bill?

Thank you so much for taking the time to introduce yourself to me.

I'll get back to you within the next 24 hours to confirm that I've received this. If you have any questions between now and then, please don't hesitate to contact me!

We are so glad you are here...

You Are Beautiful

Amount to be charged today: $

Thank you so much for taking the time to introduce yourself to me.

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