Name
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First Name
Last Name
Phone
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Email
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City
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Zip Code
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What is your racial justice work? Where do you organize and with what groups of people?
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(ie in an organization, community, synagogue, church, neighborhood, etc)
What embodiment practices do you do (for example, yoga, tai chi, aikido, time in nature, etc). Is there anything else you’d like to share with us about your healing path?
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How do you think this course will support your racial justice work?
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Have you completed an online or in-person course with Dara? If yes, when did you take it?
(This is not a requirement, but recommended.)
Please list the date of your previous ERJ course (such as St Louis Spring 2023). If you haven't taken a course with Dara before, and have completed another somatic training program, please share which one here.
Which Program are you registering for?
Are you local to or currently living in the area?
To attend, will you need a place to stay?
Note: Some trainings are residential and we invite all participants to stay in shared on-site housing. Some are not. Please answer this question to the best of your ability. Stay tuned for the course welcome packet, which contains further details about accommodations specific to your location.
After reviewing the COVID-19 policy, is there anything you would need added to make this session accessible to you? Do you have any questions about the COVID-19 policy?
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For course material purposes, are you taller than 5'9"?
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Your payment will be due upon acceptance to the course. If accepted, do you plan to pay in one lump sum, or would you like to discuss payment plan options?
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Donations and sponsorships of any amount to offset the cost of registrations for others are always welcome. Donations directly impact our ability to offer scholarships. We recognize that some people have access to funds that allow them to help pay for or offset the cost of other future participants. Especially if you are white, comfortably paying your bills, have an organization paying your tuition and/or have other class privileges, we hope you will consider the feasibility of making a contribution that is meaningful to you.
Do you consent to us sharing your contact information with other course participants? (For example, we send emails to all participants before the course begins and we would like to cc you. Similarly, we share a participant list after the course concludes and we would like to include your contact informatio nto support great community-building.)
What access needs might you have around this session? What would make these four days possible and easeful for you? We invite you to name needs below.
(for example, I need to sit sometimes. I can’t be in the sun too long, etc)
What additional information would you like to know about our time together?
Is there anything you want us to know? Any questions for Dara or other organizers of this course?