Equity Pricing Request FOR EXPLORING YOUR BODY STORY

Please complete the form below to request additional equity pricing for our Exploring Your Body Story online retreat.

Today’s Date*

Note that requests must be submitted at least 5 days prior to program start date.
Name*
First Last
Email*
Enter Email Confirm Email
Please answer honestly and check all of the following that apply to you. I identify as:*
- Black, African descent, Latino/Latinx, Indigenous, Mixed Race, Nonblack POC
- I identify as queer/trans/gender-nonconforming
- I make less than $20,000 annually
- I have a disability
- I am a student
- I am an educator
- None of the above
What are you able to pay for the program, if anything? Please add amount and payment terms below (ie. $100 at $20/month for 5 months).*
What else would you like us to know about you?
Phone
This field is for validation purposes and should be left unchanged.