Living in Alignment — Enrollment Form
Please complete this form to confirm your registration for Living in Alignment.The information you share will remain confidential between you and me and will not be shared with the group unless you choose to share it yourself. Please simply do your best with these questions. If you find yourself struggling with one, just say so in the space provided and move on. There are no right or wrong answers. I use this information to help me prepare for our sessions so we can use our time together more efficiently and personalize the experience in ways that are most meaningful and beneficial to you.
About You
First and Last Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Where You Are Right Now
How would you describe how you’re feeling right now about yourself, your life, and your relationships?
*
What is your single biggest challenge right now?
*
How is this challenge affecting you, and what would you love to experience more of in your life?
*
At the end of our 10 weeks together, what would you love to feel, experience, or be doing differently in your life?
*
Your Quantum Human Design Information
I’ll be using aspects of your Quantum Human Design chart to help personalize your experience throughout our journey. Please provide your birth information as accurately as possible.
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Birthplace City
*
Birthplace State/Province
*
Birthplace Country
*
Exact Birth Time
*
Hour Minutes
AM
PM
AM/PM Option
I don’t know my exact birth time
I don’t know my exact birth time, and I entered my best guess
How familiar are you with Quantum Human Design?
*
This is completely new to me
I know a little about it
I’m fairly familiar with my chart
I’m very familiar with Quantum Human Design
What experience, if any, do you have with EFT (Emotional Freedom Techniques)?
*
None — this will be new to me
I’ve tried it a few times
I use it occasionally
I use it regularly
Scheduling
Living in Alignment 10-week Zoom journey will be held on Mondays, 7:30pm - 9:00pm Central Time. September 14 - November 16, 2026
Is there anything else about your availability you’d like me to know? A Recording will be sent each week, however, it is best to experience live on the call.
Registration
Investment: $497.
Living In Alignment Course
prev
next
( X )
Registration
Complete payment through Stripe to confirm your place in the group.
$497.00
$
497.00
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Should be Empty: