RPY online Course Reg. Form

Reclaim the Power of YOU

Complete the form below to signup for the Online Course.
Name *

First Name Last Name
What are your pronouns?
Nick uses he/him/his
Email *
Phone # *
How did you hear about the course?

Queer Healing Journeys site Social media Queer Spirit podcast Friend/Colleague Online Search

Workshop Payment (Cost in US Dollars) *

Single Payment: Full Registration - $ 297.00

Payment Plan: $315 = 3 Monthly Payments of $ 105.00

Reclaim the Power of YOU