Workshop Request

Thank you for your interest in collaborating on a workshop! Please fill out our questionnaire below to help us get to know your vision and/or organization. Should you need assistance, please contact hello@thewellhealing.com.

Question Title

* 1. Please provide contact information:

Name *

Company *

City/Town *

State/Province *

Country *

Email Address *

Phone Number

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* 2. How did you hear about The Well?

Instagram

Facebook

Online search

Word of mouth

Other (please specify)

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* 3. What service would you like Mackala lacy to offer?

Yoga (Postural) / Meditation

Mindful Living Education

Mental Health Education

Intersectional Identity Discussion (e.g. race, gender, sexuality, etc)

Other (Please describe):

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* 4. Title, Date, and Location of workshop

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* 5. Please describe the intention of the workshop. (i.e. What do you hope participants receive from the workshop?)

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* 6. Please check all that describe your target community.

Age specific

Allies

Asian diaspora

Black diaspora

Dis- / Differently-abled

Fat / Larger Bodies

Incarcerated / Formerly Incarcerated

Indigenous / Native

Latinx

LGBTQ+

Low-income

Men

Non-minority

Non-specific

Undocumented

Women

Other (please specify)

Workshop Request

Question Title

* 1. Please provide contact information:

Question Title

* 2. How did you hear about The Well?

Question Title

* 3. What service would you like Mackala lacy to offer?

Question Title

* 4. Title, Date, and Location of workshop

Question Title

* 5. Please describe the intention of the workshop. (i.e. What do you hope participants receive from the workshop?)

Question Title

* 6. Please check all that describe your target community.

Question Title

* 7. Is there anything else we should know?