Regenerative Community Care for Marginalized Folx

1

Do any (or a combination) of the following apply to you? * This field is required.I am Black / First Nation / Indigenous / Person of Color / Queer / Trans / Non-Binary

YESNO

2

What's your name?* This field is required.What may we call you? Feel free to use an alias, if you prefer. Or a name you'd like to try out!

3

What pronouns do you currently use* This field is required.How may we refer to you?

e.g. she/her, he/him, they/them, ze/zim, ki/kin

4

Email Address* This field is required.

example@example.com

5

What country are you joining us from?Where are you located?

6

Do you have specific needs or restrictions we should be mindful of?* This field is required.We want to ensure that we an create a space that's as accessible to your needs as possible.

Hearing

Seeing

Movement & Concentration

Social Energy

Being available as care taker

Nothing specific

7

What workshop date would you like to attend?* This field is required.All workshops will be held on the first Thursday of the month, from 17-19h CEST. We aim to enable people from different time-zones to participate.

8

Is there anything else you would like us to know?

9

Newsletter

Yes, subscribe me to this newsletter.

10

Would you like to receive monthly insights & impulses from us?

Yes, I want to receive the Dr. Mega Newsletter via e-email.