program registration

May 8th Workshop

Event Overview

Registration

sdsd

Date and Time

Event Details

These are one off event details

Tuition Model & Financial Support

Deadline

Registration

section 1 of 7

What program are you interested in?

No items found.

Participant Information

Full Name *Preferred First Name *

Please let us know what you would like to be called during your training.

Certificate Name *

Please provide your name as you would like it to appear on your certification of completion

Pronouns

Please share your pronouns with us – she, he, they, etc.

Phone Number *Email Address *City / Region of Residence *

section 2 of 7

Organization

What is your current affiliation? *Organization NameOrganization WebsiteOrganization AddressPosition Title

section 3 of 7

Tuition Selection

Tuition Options *

section 4 of 7

Program Readiness

Please provide a brief description of the work that you do and how this program would support your work. *What do you hope to learn from this program? *We invite participants to use their personal inner work practices throughout the course. Do you have any regular inner work practices? If so, which ones? If not, are there practices that you are interested in exploring? *At Inner Activist, we value deep commitment to equity and inclusion. Challenging moments of learning may emerge in our group process as we explore inner work in the context of social change. Please tell us about your ability to learn in a cohort of participants from diverse backgrounds and experiences of power and privilege. *Have you had previous training in anti-oppression, anti-racism, and intersectionality? If so, please list.

section 5 of 7

Accommodation & Dietary Preferences

All of our programs are shared occupancy. We arrange accommodation based on age and gender of participants. If you would like us to consider any particular preferences or needs when assigning rooms, please specify below.

Age *Gender

Please select any/all choices with which you identify

FemaleTransgender Woman MaleTransgender Man Non-binary Please list any special needs

section 6 of 7

Emergency Contact Information

Please let us know who to contact in case of an emergency.

Full Name of Emergency Contact *Relationship Mobile PhoneWork PhoneHome PhoneEmail Address

section 7 of 7

Demographic Information

The Inner Activist prioritizes justice, diversity, equity, and inclusion. One of the ways we ensure this is by ensuring our programs are representative of our community. Please select any/all choices with which you identify. These fields are all optional.

Race / EthniticityAfrican/BlackArab/Middle Eastern Asian/East Asian Asian/South Asian LatinxMixed/Multiracial IndigenousWhite/EuropeanSexual Orientation BisexualGayHeterosexual/StraightLesbianQueerMobility and NeurodiversityReligion/FaithI confirm that I am 18 years of age or older *

Thank you! Your application has been received. We will be in touch with you shortly. Be well.

Go to our homepage

Please make sure to fill all the required fields.

section 1 of 4

What program are you interested in? *

No items found.

section 2 of 4

Participant Information

Full Name *Preferred First Name *

Please let us know what you would like to be called during your training.

Pronouns

Please share your pronouns with us – she, he, they, etc.

Phone Number *Email Address *City / Region of Residence *

section 3 of 4

Organization

What is your current affiliation? *Organization NamePosition Title

section 4 of 4

Access Needs

Please list any special needs

I confirm that I am 18 years of age or older *

Thank you! Your application has been received.

Go to our homepage

Please make sure to fill all the required fields.

Conscious Use of Power Building Personal Mastery Taster Workshops Custom Programs

Blog About Us Contact Us Upcoming Events

The work of the Inner Activist takes place on unceded and unsurrendered Coast Salish lands and waters. We stand in solidarity with Indigenous people here and around the globe.

The Inner Activist is a project of MakeWay

Made with love by Good Kind

Support our work

Stay in touch

Thank you for signing up for our newsletter. Check your inbox for updates.

Oops! Did you enter your email properly?