Register — Healing for Queer Healers

Welcome! I’m so glad you are joining us. Please fill out the form below to reserve your spot. Once I receive it, I’ll follow up by email within 24 hours with your payment link and next steps.

Name

First Name

Last Name

If you'd like to share your pronouns, here is the space to do so.

Phone

Just in case I need to reach you directly

(###)

###

####

Email

Address

What is your relationship to the queer community?

How did you first hear about the retreat?

Dietary Needs

Vegan

Vegetarian

Gluten Free

Payment Intention (Sliding Scale: $475–$1,200+)

Please consider your privileges, barriers, ancestry, access to money currently, and ability to make money in the future. Then choose based on what feels right for you. The rate you determine will be honored and not questioned. Please enter the amount below. Example "$850" or "$650"...

Payment Option

Payments can be made weekly, every other week, or in 2–3 installments—whatever works best for you. The full balance is due by September 5th, 2025.

I'd like to make payment in full now.

I’d like to start with a deposit and pay the rest over time.

Do you have any questions, concerns, or anything you'd like me to know before I follow up?