Ahdama Remembrance Application Form:
This application has been created so that we might better understand you and your needs. All the information shared on this form will remain completely confidential. Thank you for your trust in us and your interest in the Ahdama Brotherhood.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you a returning participant?
*
Yes
No
Age
*
Where do you live? (City and Country)
*
Martial status:
*
Single
Married
Divorced
Something else
Which Remembrance are you applying for?
*
June 11 - 14
October 15 - 18
Add Me To Your Mailing List
Do you have any food allergies or dietary restrictions? (All Food Is Kosher)
*
Why would you like to attend this remembrance? (Be as specific as possible. Your answers are confidential)
*
Have you ever participated in similar events? If your answer is no, why have you decided to participate now?
*
What would make this remembrance a successful experience for you?
*
Do you have any medical conditions (mental and/or physical) that we need to be aware of?
*
Are you taking any prescription medications?
*
What is your relationship with substances? Do you have a history of substance abuse?
*
Are you currently working with a coach or therapist?
Yes
No
Shirt Size
Small
Medium
Large
XL
XXL
Were you referred by someone? If not, how did you hear about Ahdama?
Are you ready to invest in yourself?
Time
Energy
Discomfort Necessary To Grow
Money
Do you commit to respecting the space and keeping confidentiality?
*
Which investment range feels most aligned for a multi-day, all inclusive, facilitated men’s retreat and access to the Ahdama Brotherhood with in person circles, online cohorts and more?
*
$1,500–$2,500
$2,500–$3,900
I’m unsure and would need a conversation
Is there anything else you would like us to know about you?
Submit
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