Equity Pricing Request FOR EXPLORING YOUR BODY STORY

Our January 2021 retreat has filled. If you complete the form below, we will reach out when our next retreat dates are announced.

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
Which date do you prefer?*
- Next date available
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 and can provide tax statements if requested
- I have a disability
- I am a student with valid ID
- I am an educator
Have you requested Equity Pricing before?*
- Yes
- No
If yes, when and for what program?
What draws you to this program right now?*
Why would you like to receive Equity Pricing?*
What are you able to pay for the program? Amount and payment terms are required (ie. $100 at $20/month for 5 months).*
What else would you like us to know about you?*
Email
This field is for validation purposes and should be left unchanged.