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1. Name (First and Last):

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2. email address:

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3. Age:

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4. Role/Position

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5. What are your current challenges with midlife? (Choose all that apply)

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6. Please share additional specifics on your challenges.

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7. With whom are you currently working (select all that apply):

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8. Please rank your interest in and availability for the following offerings for participating in "Midlife: The Heart of my Story:"

 
A 3-hour workshop over Zoom
An in person summer retreat in a beautiful, restorative setting
A seasonal retreat series over the course of a year; some in person, some online
Group spiritual direction via Zoom over a 9-month period

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9. What outcomes would you want or hope for from "Midlife: The Heart of My Story?"

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