Reclaim Your Seat — January 9, 2027 Registration Request
Submit your details for a clinical suitability screening—this is a request only, not confirmed registration. Lunch is included.
Welcome to Reclaim Your Seat, a women’s one-day experiential therapeutic intensive on Saturday, January 9, 2027, from 9:30 AM to 5:30 PM. Lunch is included. EARLY-BIRD registration is $595 through December 20, 2026; regular registration is $650 after December 20, 2026. The event is limited to 12 participants. Submitting this request does not confirm your registration. Clinical suitability screening and approval must happen before payment. If approved, you will receive a separate secure Jotform payment link and registration instructions.
Full name
*
First Name
Last Name
Email
*
example@example.com
Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
Preferred contact method
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Email
Phone
Nonclinical logistical questions or accessibility accommodation request
Acknowledgment
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I understand that submitting this form does not reserve or confirm my place. Participation is subject to a separate clinical suitability screening and approval. If approved, I will receive a separate secure Jotform payment link and registration instructions.
Optional consent to be contacted about this event
Yes, I consent to being contacted about this event.
Request My Seat
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