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Dear High-Functioning Woman,

As part of our registration process, we request that you complete this confidential survey. We want to be intentional about selecting a powerful group of woman that have both commonalities and differences. For this particular EXPERIENCE, we want to ensure as much as possible that the networking is meaningful for all in attendance.

Please complete the following application to be considered for attendance at the First Annual wholeSOUL Experience: A Retreat for Highly Functioning Women on April 7-11, 2019. We would like to learn more about you and your goals for attending. In addition, we are asking some identification questions because we intentionally want to foster a diverse learning community. Once your application is accepted, we will contact you from essence@pinkconsultingllc.com with payment options for the participant fee.

The survey is not anonymous, but individual survey responses will only be available to the facilitator. All data collected will be aggregated and de-identified before it is shared at the retreat or in any other presentation.

If you have any questions, please feel free to contact me.

Respectfully,
Phyllis D. Braxton-Frierson
President & Founder
PINK Consulting, LLC &
The wholeSOUL Experience
phyllis@pinkconsultingllc.com

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* 1. First name?

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* 2. Last name?

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* 3. Email?

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* 4. Mailing address?

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* 5. City?

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* 6. State?

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* 7. Current country of  residence?

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* 8. Organization/Affiliation?

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* 9. Title/Position/Role?

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* 10. Age?

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