Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What holds you back from building relationships inside/outside the home?

anxiety/depression

fear of judgment

introvert/preference to be alone

busy life/lots of irons in the fire

feel like you're not good company

nothing! we love getting out and being with people.

What vehicle do you prefer when seeking inspiration/grounding?

podcasts

books

in-person/small group setting

online forums/groups

Photo release preference:

I authorize use of photos of our family in marketing/social media and other publicly viewed platforms.

I do not authorize use of photos of our family.