Form

THRIVING LIFE

COMPASSIONATE NOTICING REGISTRATION

(One person per registration form, please.)
First Name: *
Last Name: *
E-mail: *

Confirmation Email
Phone Number:

- Country Code - Area Code Phone Number
City: *
State or Province *
Country *
What's the location of the event you're registering for?

Portland, OR Minneapolis/St. Paul, MN Telephone
What event(s) are you registering for? (please check all that apply) *ALL CN EVENTS ARE OFFERED BY TELEPHONE, all times are PACIFIC* *

INTRODUCTION to Compassionate Noticing + CN Practice Group (Thursday February 8, 10am-12:30pm) $25 CN Practice Group (Thursdays, 11am-12:30pm Pacific) $10-$30 sliding scale per session
How did you FIRST hear about Vika or Thriving Life?

From a Friend, Family Member, Neighbor, Colleague, Therapist, etc. (please specify below) Internet Search (Google, Yahoo, Ask, etc.) Facebook Page for this Free Intro event Presence Practice Facebook page Vika's ThrivingLife Facebook page Thriving Life Institute Facebook page Thriving Life email CNVC Website ORNCC NVC Website ORNCC NVC Newsletter Sacred Circle Dance list Other (please specify below)
What "other" way, or through whose recommendation, did you FIRST hear about Vika or Thriving Life?
Do you have any experience with NVC? (none is required!)

No I've just heard about it, and I'm curious I've read at least part of "the book" - NVC A Language of Life, by Marshall Rosenberg I've taken a workshop or class I've participated in an NVC Practice Group of some kind I've taken classes &/or workshops, AND participated in an NVC Practice Group (less than 1 year) I've taken classes &/or workshops, AND participated in an NVC Practice Group (1-3 years) I've taken classes &/or workshops, AND participated in an NVC Practice Group (more than 3 years) I've taught NVC
Do you have any experience with brain science (Interpersonal Neurobiology / Attachment Theory)? (none is required)

No Yes, brain science Yes, attachment theory Yes, both
Are you a mental health, personal development, or other helping professional?

No Yes, I'm a mental health professional Yes, I'm preparing for a career as a mental health professional Yes, I'm a coach or other personal development professional Yes, I'm preparing for a career as a coach or other personal development professional Yes, other (please specify below)
What "other" helping professional role do you have?
What are you hoping to experience or develop, from participating in this mindfulness practice? *
What are 3 situations that you find the most upsetting (that "step on your broken toes")? For example, when people express upset at something you've done, when something you're using breaks or doesn't work, when you make a mistake, etc.
Wondering what a "broken toe" is?

Click here for a quick video that's amazingly helpful in explaining what "goes wrong" in our relationships!
Please confimr the date you'd first like to join our CN Practice Group (11am-12:30pm Pacific/UTC-7)

- Month - Day Year
Date
Is there anything else you'd like me to know?
To complete your registration and receive the event details, click the "submit" button below.

Please add thrive@thrivinglifenvc.org and vika.thrivinglife@gmail.com to your "safe senders" email list, and watch your inbox or spam filter for your confirmation email.

I look forward to meeting you!

Warmly,

Vika Miller, MA
Thriving Life & Community
503-395-5366
thrive@thrivinglifenvc.org
www.thrivinglifenvc.org
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