Name *

First Name

Last Name

Have you previously participated in a Mindful Grieving Program? *

Yes

No

What days of the week would generally be good for you to join a weekly, 2-hour class via Zoom? *

Select all that apply

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What times of day would generally be good for you to join a weekly, 2-hour class via Zoom? *

Select all that apply

Mornings

Afternoons

Evenings

Are you interested in applying for a scholarship? *

Yes

No

Would you like to be added to my email list to receive occasional updates on my schedule and offerings? (No spam or daily emails, I promise!) *

Yes

No