Welcoming The Darkness Registration Form

Thank you and welcome to Welcoming the Darkness!

I am honoured and excited to be your guide and companion along this journey and this next phase of your life.

So we can maximise the use of our time durig the program and create some clear expectations and parameters please complete the form below.

Please answer all questions clearly and honesty. Your information is kept condfidential and is only accessed by myself.

Thank you for your time and I look forward to connecting with you soon.

Cheers

Nic

Full Name*

First NameLast Name

Mobile Number

E-mail*

example@example.com

Date of birth*

DayMonthYear

Facebook Name

Current Relationship Status

Are you currently experiencing any physical, psychological or emotional health complaints?

NoYes (please give details below, including medication)

Please explain why you want to join the Welcoming the Darkness program

What are the three greatest challenges in your life right now?

What emotional patterns are you aware of that hold you back from fully being yourself?

What would be an outstanding outcome for you as a result of doing this program?

What would that outcome give you?

What comes to mind when you read the word Darkness?

Thank you for taking the time to complete this form.

I will review your submission and will be in contact soon with more information.

I look forward to connecting with you soon!

Payment Options

Full Payment($797.00AUD one-time payment)

Payment Plan($280.00AUD for each two weeks)

3 fortnightly payments of $280

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