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* 1. Please share you name and email address (for follow up)

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* 2. While societally we face many pressing issues, I would like to see Shambhala’s Bay Area social engagement efforts focused here first:

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* 3. I would like to be part of a community conversation to discuss Shambhala’s Bay Area social engagement efforts.

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* 4. I would like to be part of a team to help shape how Shambhala’s Bay Area social engagement efforts move forward.  

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* 5. I volunteer for a non-profit organization outside of Shambhala.  

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* 6. If you answered yes above, please share the name of this organization:

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* 7. I identify as LGBTQ and am interested in participating in a Shambhala group of other LGBTQ- identified people for connection, community, and support.

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* 8. I identify as a PoC and am interested in participating in a Shambhala group of other PoC for connection, community and support.

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* 9. I am interested in attending a women's or men's Heart of Recovery gathering, a Shambhala meditation and discussion group that supports people in any addiction recovery. [These groups would be gender specific]

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* 10. I am a white or white-appearing individual and interested in participating in a Shambhala group to examine white cultural conditioning.

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