Building Bridges Registration Form

Building Bridges Cohort

Welcome, we’re excited that you’re interested in being a part of the Building Bridges cohort! We look forward to being with you on this learning journey.
Name

First NameLast Name
Email
example@example.com
Organization / Community (optional)
What are some motivating factors guiding you to join this cohort? Feel free to share as little or as much as you feel called.
Contribution

To make participation accessible to as possible, we use a sliding scale model for tuition. This allows participants to choose a contribution that reflects their financial situation, ensuring that resources are not a barrier to joining. Together, we cultivate a diverse, supportive community where everyone can grow, share, and create impact.

Consider contributing MORE on the scale if you:
- Comfortably meet your basic needs
- Belong to a sponsoring organization or have full-time employment
- Have investments, retirement funds, or inherited wealth
- Travel recreationally
- Have access to family resources
- Work part-time by choice
- Own your home
- Benefit from social or economic privilege (e.g. education, race, gender, class)
Consider contributing LESS on the scale if you:
- Struggle to meet basic expenses
- Support dependents
- Have significant debt or uncovered medical costs
- Are an elder with limited financial support
- Are an unpaid community organizer
- Experience housing instability or unreliable transportation
- Cannot afford time off due to financial constraints
(Inspired by the “Green Bottle” sliding scale model by Alexis J. Cunningfolk | www.wortsandcunning.com)
Sliding Scale Options (All amounts in CAD)

Tier A - $1050Tier B - $900Tier C - $750
Total

Payment Amount

CADDescription

Credit Card Details*
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

*If paying by credit card isn’t possible for you, please don’t let that be a barrier. Reach out to us at info@bloomworld.org, and we’ll be glad to explore other payment options together.
Optional Coaching Support - Individual and group conflict coaching is available on a slide scale from $175 - $225/hour. Would you be interested in this option? If yes or maybe, we will reach out with more information.

YesNoMaybe
Thank You & Next Steps

Thank you for choosing to be a part of the Building Bridges cohort! We hope this learning journey will support you to develop the mindsets, skill sets, and structures to transform workplace conflict from division and breakdown into connection and breakthrough.

We will follow up with more information about the cohort in the months leading up to the start date.

If you have any questions or need support along the way, feel free to reach out to Dan at info@bloomworld.org.

With gratitude,
Jeff, Moyo & Rehana
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Building Bridges Cohort