Fall 2017 Daytime Rising Strong Registration Form

Registration Information

The Fall 2017 Rising Strong group will begin on Monday, September 18, 2017 and run through November 6, 2017. The group will not meet Monday, October 16. The classes will meet from 1pm-3pm at Sioux Falls Seminary, Room 205. The cost of the class is $300. Full payment is due the first day of class (check or cash) or you can work out a payment plan with Melissa. A confirmation email will be sent with an option to pay with credit card. 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 class 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. What sparked your interest about being a part of a Rising Strong group?

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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

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 Rising Strong 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 set up a payment plan.

I would like to pay with a credit card. ($8.50 Credit Card Fee)