SSCTLC registration form Somatic Self-Compassion Teaching and Learning Course (SSCTLC): Embodied Trauma-Informed Contemplative Teaching and Diving Deeper into SSC EmailThis field is for validation purposes and should be left unchanged.Please Note:If you choose the PayPal option and you are not taken to the PayPal page after completing this form, it's likely that you have missed completing one of the required fields. Please check to see if there is an error message if you are not taken to PayPal.About you:General Data Protection Regulation (GDPR) Agreement* I consent to having this website store my submitted information so they can respond to my inquiry Name* First Last Email address* My pronouns are (e.g. she, her, hers; he, him, his; they, them, theirs)A little more about you:Address City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country To help us work with you:The questions below are designed to help us support you the most as you take this course with us. Please free free to contact Kristy Arbon (kristy@heartworks.training), if you have personal concerns that you would rather discuss in person. Your information will be kept confidential.What do you hope to get out of this training?Are there any physical or mental health concerns/conditions that might affect your participation in this program?Have you experienced things you would consider traumatic in your life? If so, are they still affecting you? How are they affecting you (e.g. flashbacks, nightmares, intrusive thoughts, difficulty concentrating)?Have you done any meditation before? If so what kind, and was it helpful?Is there anything else you'd like us to know so that we can support you?How did you hear about this course?*Please choose all that apply. Social Media Word of Mouth HeartWorks website Email notification from Kristy Course selection and registration:Registration*Please choose your investment below (in US dollars). Please contact Kristy (kristy@heartworks.training) if you need to discuss a different investment arrangement. I don't want finances to get in the way of you accessing this course. I'll invest $120 I'll invest $160 I'll invest $200 I'll invest $240 I'll invest $280 I'll invest $320 I'll invest $360 I'll invest $400 Payment Type* PayPal/Credit Card If you are paying by check, please make the check out to: Kristy Arbon HeartWorks Training PO Box 510441 St Louis, MO 63151Total $0.00 Δ