Staff Confirmation Payment Form – Woman Within South Central USA

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Staff Confirmation Payment FormCharlene2017-07-06T11:25:25-05:00

Staff Confirmation Payment Form

Staffing Fee
Billing Information
I was selected to staff the following Woman Within Weekend:*
First Name*
Last Name*
Address*
Address 2
City*
State / Province*
Zip / Postal Code*
Email Address*
Mobile*
Alternate Phone
Total
$0.00
Comments
This field is for validation purposes and should be left unchanged.

Woman Within welcomes all women and prohibits discrimination based on race, color, gender, national origin, age, religion, disability, veteran’s status, sexual orientation, and gender identity.

Woman Within South Central USA is a 501(c)3 non-profit organization and a member of The Woman Within International network.

*Please note: Woman Within programs and circles are neither a therapy group, nor a place for deep process work. You are responsible for your own participation and well-being. If you are consulting with a doctor or therapist we recommend that you seek their approval if you wish to join the guided circle. If emotional issues are triggered, you may need to strengthen your support network and seek professional help through therapy or other healing.

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