TL REGISTRATION

THRIVING LIFE

EVENT REGISTRATION
First Name*
Last Name*
E-mail*

Confirmation Email
Phone Number (preferably your cell, so we can reach you on the event day if needed)*
Please re-enter your phone number*
City*
State or Province*
Country
What is the date of the event you're registering for? (use format XX-XX-XXXX)
MonthDayYear
What's the location of the event you're registering for?*
Portland, OR (Inner NE)Minneapolis/St. Paul, MNOnline Webinar
What event(s) are you registering for? (please check all that apply)*
PORTLAND: Self-Love, Healthy Boundaries, and Vibrant Thriving (Mon July 22, 6:30-9pm)ONLINE Self-Love, Healthy Boundaries, and Vibrant Thriving (Mon July 29, 5:30-7:30pm Pacific)PORTLAND: FUTURE offering of Self-Love, Healthy Boundaries, and Vibrant ThrivingONLINE: FUTURE offering of Self-Love, Healthy Boundaries, and Vibrant Thriving
What contribution do you feel inspired to make for this event(s)?*
$10-$15 sliding scale per event; student/special circumstances: $5-$7 per event. No one turned away for lack of funds.
How did you FIRST hear about Vika or Thriving Life?*
From a Friend, Family Member, Neighbor, Colleague, Therapist, etc. (please specify below)Internet Search (Google, Yahoo, Ask, etc.)Facebook Page for this eventThriving Life emailCNVC WebsiteORNCC NVC WebsiteORNCC NVC NewsletterSacred Circle Dance listMeetup - Thriving Life NVCMeetup - Adventures in ThrivingMeetup - Awakened RelationshpsIt was so long ago, I can't remember!Other
How did you hear about this event (if different from above)?
Do you have any experience with NVC?
NoI've just heard about it, and I'm curiousI've read at least part of "the book" - NVC A Language of Life, by Marshall RosenbergI've taken a workshop or classI've participated in an NVC Practice Group of some kindI've taken classes &/or workshops, AND participated in an NVC Practice Group (less than 1 year)I've taken classes &/or workshops, AND participated in an NVC Practice Group (1-3 years)I've taken classes &/or workshops, AND participated in an NVC Practice Group (more than 3 years)I've taught NVC
Do you have any experience with Relational Neuroscience (a.k.a. Interpersonal Neurobiology) or Attachment Theory? (none is required)
NoYes
Are you a mental health, personal development, or other helping professional?*
NoYes, I'm a mental health professionalYes, I'm preparing for a career as a mental health professionalYes, I'm a coach or other personal development professionalYes, I'm preparing for a career as a coach or other personal development professionalYes, other (please specify below)
What "other" helping professional role do you have?
What questions would you most like to have answered, or what challenges are you hoping to get support for, from this/these events?*
What are 3 situations that you find the most upsetting (that "step on your broken toes")? For example, when people express upset at something you've done, when something you're using breaks or doesn't work, when you make a mistake, etc.*
Wondering what a "broken toe" is?
Click here for a quick video that's amazingly helpful in explaining what "goes wrong" in our relationships!
Is there anything else you'd like to share, or do you have any questions?
To complete your registration, click the "submit" button below and make your contribution.
The event location details will be provided with your registration confirmation. (Space is limited, and we want to make sure there's room for everyone.)
Please add thrive@thrivinglifenvc.org and vika.thrivinglife@gmail.com to your "safe senders" email list, and watch your inbox or spam filter to ensure you receive your confirmation email.
I look forward to meeting you!
Warmly,
Vika Miller, MA
Thriving Life & Community
503-395-5366
thrive@thrivinglifenvc.org
www.thrivinglifenvc.org
www.twitter.com/vikathriving
www.facebook.com/thrivingvillageinternational
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