Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Your Human Design Info: * Birthdate/time/location(exact) Your Child(s) Human Design Info * Name/Birthdate/time/location(exact) What are your goals and aspirations as a mother? (Please describe briefly): * What are the biggest challenges you currently face in motherhood? * Program Expectations What do you hope to gain from participating in the "Motherhood Redesigned" program? * Are you interested in additional 1:1 coaching? * Yes No Have you previously explored Human Design or Positive Discipline concepts? * Yes No If yes, please briefly describe your experience or familiarity with these concepts: Commitment Can you commit to being in person in San Diego for the half-day workshop on November 17th? * Yes No Additional Comments or Questions: Thank you for submitting your answers! I look forward to seeing you on November 17th! If you have any additional questions please feel free to email me kimberly@kimberly-virginia.com
