Thank you for your interest in touching lives through the power of words! Please, answer each of the questions as fully and concisely as possible.

Contact Information

Name:(Required)
Address:(Required)
Are you over 21 years old?(Required)
Are you willing to have a Police Reference check?(Required)

Availability

When are you available to facilitate a workshop?
Morning(Required)
Afternoon(Required)
Evening(Required)
Dates (Approx.)
Dates (Approx.)

Questions

(This question bears no weight in considering your application)
(This application will be date-stamped upon submission.)
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