Winter 2019 Daring Greatly™ Registration Form

Registration Information

The Winter 2019 Daring Greatly™ group will meet on Wednesday nights from January 16 - March 6, 2019 for a total of 7 weeks. (The group will not meet on Wednesday, February 6.) The group will meet from 6:30-8:30 pm, the location is still being determined. The cost of the group is $300. Full payment is due the first day of class or you can work out a payment plan with Melissa. A confirmation email will be sent with a link to pay by credit card, if so desired. Because enrollment is limited there are no refunds. If you need to drop out of the group, you will be given an opportunity to sign up for a future group at no additional charge.

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* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Why are you interested in the Daring Way?

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* 3. Have you seen or read any of the following Brene' Brown books or TedTalks?

Thought It Was Just Me (but it isn't): Making the Journey from "What Will People Think?" to "I Am Enough"

The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are

Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead

Rising Strong: The Reckoning, The Rumble, The Revolution

Braving the Wilderness: The Quest for True Belonging

TedTalk: The Power of Vulnerability

TedTalk: Listening to Shame

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* 4. What would you like to accomplish as a result of attending the Daring Way group?

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* 5. There will be opportunities to share with and listen to others. How do you imagine this will be for you? Please note, you share to the level with which you are comfortable.

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* 6. What life transitions or issues are you currently navigating?

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* 7. Do you have a therapist or counselor you could work with if something came up in the group requiring individual attention?

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* 8. What else would you like me to know about you?

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* 9. Payment Options

I will pay $300 by cash/check the first night of class.

I would like to pay by credit card.

I would like to set up a payment plan.