Rewiring Together
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Rewiring Together
Rewiring for Clarity
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Registration Form
Rewiring for Clarity
*
Indicates required field
Basic Info
Name
*
First
Last
Phone Number
*
Email
*
City and State
*
Date of Course
*
November 17-19, 2023
How did you hear of this workshop?
*
Personal Development & Questions
?
Please specify any personal development work you have done. and any other concerns or questions.
*
Travel
Workshop is 90 minutes due west from Washington D.C., and 75 minutes from Dulles Airport
*
I will drive myself to the course
I am willing to carpool
Flying into Dulles Airport and like a ride
Still to be determined
Additional travel information or requests
*
Dietary Restrictions
Please note we may not be able to accommodate
all
dietary needs, we’ll let you know if you’ll need to supplement with your own food.
Dietary restrictions
*
1. No restriction
2. Vegetarian
3. Vegan
4. Gluten Free
5. Dairy Free
6. Will bring my own meals
7. Other - I will make comments below.
Food Allergies, if so what? Any other food information we should be aware of?
*
Food Allergies, if so what? Any other food information we should be aware of?
Additional Information
Any other special needs, concerns we need to be aware of?
*
Deposit Payment Options
Total cost: $1250. If this cost is prohibitive for you, please ask us about our scholarship program.
Deposit - please pay 50% ($625) to reserve your spot. The balance is due two week prior.
*
Venmo - @Leslie-Traub
Pay by Check - will send an email to Leslie (rewiringtogether@gmail.com) requesting her mailing address.
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Once you have completed this form please click the
"Submit" button to finalize your
registration
SUBMIT
Rewiring Programs
Rewiring Together
Rewiring for Clarity
About Us
Testimonials
Logistics
Registration
Register for Rewiring Together
Register for Rewiring for Clarity
Participants
New Participants Pre-Work
What to Bring
Graduates
Blog & News
Contact Us