Somatics, Trauma and Resilience Dojo

Somatics, Trauma and Resilience

Registration & Payment

July 21 - 24, 2022
Petaluma, CA

Learn how we are safely delivering in-person trainings during the times of COVID

Participant Information

Please submit this form for each participant so we may collect all information for each participant. For questions about large quantity orders, please reach out to support@strozziinstitute.com.

First Name *

Last Name *

Email *

Phone *

Birth Date *

Company *

Job Title *

Referral

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Demographic Information

These demographic questions are optional. By gathering this data we are able to better understand who is participating in our courses.

With which race/ethnicity do you identify? (Optional)

Select all that apply

Black / African Descent

First Nations / Indigenous

Pacific Islander

Latinx

MENA - Middle Eastern / North African

South Asian

East Asian

White

Another

What gender pronouns do you use? (Optional)

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She / Her / Hers

He / Him / His

They / Them / Theirs

Another

With which of these class identities do you currently identify? (Optional)

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Poor / Working Poor Class

Working Class

Middle / Professional Class

Upper Middle / Upper Professional Class

Upper Class (New Money)

Upper Class (Inherited)

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