New Customer Registration Form

Purple Dialogue Application

Let's Get To Know Each Other!
Thank you for your interest in our Purple Dialogue Community! To ensure this space remains meaningful and supportive for all members, we ask that you answer the following questions thoughtfully. There is no obligation to join by filling out the application.
Why are you interested in joining the Purple Dialogue Community?
(What drew you to this movement, and what do you hope to gain?)
How would you say you currently approach conversations with people who have different perspectives than your own?

Avoid confrontation at all costsKeep quiet, even if I think I have a good ideaGet emotional; shout, yell, cry, to get my point acrossBecome a bully to get my wayGet curious and try to find common groundOther
If other, please specify
Please describe a time when you successfully resolved a conflict or misunderstanding through dialogue.
(If this hasn't happened yet, share what you'd like to learn about handling conflict.)
What skills or qualities do you hope to develop by being part of this community?
(Examples might include active listening, empathy, leadership, or problem-solving.)
What skills or qualities do you anticipate bringing to the community?
Are you open to giving and receiving constructive feedback as part of your growth in this community?
Next Steps:

Our team will review your responses and be in touch with next steps. We value authenticity and a willingess to learn over perfection.

Let's work together to build bridges, foster understanding, and create meaningful change.
Full Name*

First NameLast Name
Mailing Address (so we can send you fun stuff once in a while!)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Who may we thank for telling you about us?
Should be Empty:

Purple Dialogue Application