Name *

First Name

Last Name

Phone *

(###)

###

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Payment *

I will pay the full value (Tier 1) up front knowing it can support a scholarship

I will pay up front on the sliding scale

I am requesting a partial scholarship

Attendance *

Bi-weekly meeting on Tuesdays 6:30-8:00pm EDT starting on April 21st and ending on August 31st via Zoom. There will be a limit to how many bi-weekly sessions I miss or skip - maximum 2. I am able to commit to the full 4 month journey, showing up for at least 8 of the session.

Yes

No