Registering for the Daring Way™ & Rising Strong™

You can use this form for both the Daring Way™ and Rising Strong™

Name
Date
Age
Occupation/School
Maritial Status
- Single
- Married
- Partnered
- Separated
- Divorced
- Widow(er)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
What is the best way to reach you?
If by phone can I leave a message?
- Yes
- No
What sparked your interest in the Daring Way™?
What would you like to accomplish as a result of attending the group?
What previous experience have you had, if any, with group therapy or a support group?
What concerns, if any, do you have about participating in a group experience?
Could you imagine any challenges sharing in within a small group? If so what might they be?
What else would you like us to know about you?
Thank you for your interest in the Daring Way™

You will be contacted by phone for a brief phone call prior to the start of the group. If you have any other questions about the group please contact Alison Withey at alison@alisonwithey.com 206-250-9060,.

Reading Daring Greatly, The Gifts of Imperfection and Rising Strong by Brené Brown is very helpful but is not required for group participation.