testing form • Mary Shields PhD

Spiritual Transformation Group Application

Full Name*

Email*

Street Address*

City*

State or Province*

Postal Code*

Country*

USA

Canada

Germany

Other

Phone*

What do you hope to get out of this group? *

Please tell me a little about your spiritual path. How are you connected with the Divine?*

Are you comfortable with extended periods of silence?*

This group depends on being respectful of others' experiences and emotions. The ability to keep confidences is crucial to the growth and well-being of the group. Are you willing to make this commitment?*

Are you able to be fearlessly self aware and do you have a willingness to learn?*

Yes

No

Are you willing and able to commit to all five dates? October 26, November 23, December 28, January 25 and February 22*

Yes

No

Is there anything else you would like to share?