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Healers Village: Black Healers Gathering Registration

Please Join Us!

Come and break bread with other Black healers get updates on what is happening and hear about upcoming opportunities. We will also be discussing what supports are needed in the current climate. We want to meet new healers and those who have not been part of the “Healers Gatherings” before. Please invite those who are like minded and would benefit.
1.Full Name and Credentials:(Required.)
2.Work Email:(Required.)
3.Personal Email:
4.Mobile Phone #:(Required.)
5.Home zip code:(Required.)
6.Which race do you identify with (check all that apply):(Required.)
7.I identify as Latino or Latina?(Required.)
8.How would you describe your gender? (check all that apply)
9.I identify a person of Trans experience(Required.)
10.Preferred Pronouns:(Required.)
11.My age range:(Required.)
12.I work at:(Required.)
13.Discipline:(Required.)
14.What topics would you like addressed at the gathering?(Required.)
15.Is it ok to share your contact information with other members of the training?(Required.)
16.Please share any special needs we should be aware of?
17.Please check any dietary needs.