The Special Needs Mama Bear Workshop
Registration Form
*
indicates required
Name:
Email:
Comment:
Workshop Name
*
The Blueprint: Reclaiming the Reins of Your Life as a Special Needs Mama
Workshop Date
*
Thursday January 30, 2025 (In-Person)
Saturday February 22, 2025 (In-Person)
Thursday February 27, 2025 (Virtual)
Saturday March 8, 2025 (Virtual)
Select date
Full Name
*
Gender
*
Email Address
*
Please ensure email is accurate for receiving materials and updates
Phone Number
Optional, for last-minute updates or urgent communication
Child's Gender
*
Child's Age
*
Child's Diagnosis
Location/City
Preferred Workshop Format
Virtual
In-Person
Additional Agreement Section
I confirm that the information provided is accurate and that I agree to receive workshop-related upd
I understand that my contact information will be used solely for communication about this workshop a
Workshops
The Special Needs Mama Blueprint Workshop - In Person
The Special Needs Mama Blueprint Workshop - Virtual