Name *

First Name

Last Name

Phone

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###

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What offering(s) are you interested in? *

Handstand Training

Partner Acro Training

Strength/Mobility Training

Political Peer Mentorship - 4 Session Package

Couples Counseling for Comrades

Facilitation/Consulting

Other - Custom

Positionality

My work seeks to center those who have been traditionally marginalized or undervalued in other services. Please select if any of the following identities, positionalities, or communities align with your experience. This is optional and your answer is confidential. It is just for my information -- it will not impact your ability to work with me. Person of the global majority / Black, Indigenous, Person of Color (BIPOC) Immigrant or non-citizen of the so-called United States LGB/queer+ Transgender, nonbinary, or gender expansive Disabled, mad, or chronically ill Formerly incarcerated Fat, person with obesity, or non-normative body size

1 of these applies to me

2+ of these apply to me

NONE of these apply to me

How soon are you hoping to begin working together?

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DD

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