Tao of Trauma Monthly Case Consultation Group Registration

Name*

Email*

We have been having problems with certain email providers, including Yahoo and AOL. If your primary email is with YAHOO or AOL, please also leave an alternate email below.

Alternate Email

For YAHOO and AOL users

Phone Number*

Address*

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

I am licensed as a:*

BIPOC, LGBTQ+, or First-Generation Immigrant?

In the spirit of cultural transformation through healing, if you are BIPOC, LGBTQ+, or a first-generation immigrant, please check this box to receive 25% off fees.

BIPOC, LGBTQ+, or first-generation immigrant

I am registering for:

Fees reflect 25% discount

Which 6 sessions do you plan on attending?

Dates are: Dec 13, Jan 17, Feb 7, Mar 14, Apr 11, May 9, Jun 6, Jul 11, Aug 8, Sep 19

Other Payment Amount

Enter other (if any) payment amount here.

Payment Method*

Checks should be made payable to "Integrative Healing, LLC" and mailed to Integrative Healing, LLC, PO Box 204, Hyattsville, MD 20781. Receipt of your fee will hold your space.

Credit Card
Check

Total

$0.00

Credit Card

Card Details

Cardholder Name

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