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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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