Ancestral Healing IFS Registration

General Information

Name

First Name

Last Name

Pronouns

i.e. they/them, she/her, he/him, etc

Where in the world do you currently live?

What is your age?

What experience do you have with the theory and practice of IFS?

We ask all participants to have a general knowledge of IFS, as we will not be introducing IFS.

Do you have experience with Ancestral Medicine's method of ancestral lineage healing?

No prior experience is needed.

What is your interest in taking this course? Do you have specific goals or intentions?

Knowing that unexpected circumstances may arise, do you expect to be available for all 7 sessions of the course?

If no, please share briefly. (Recordings will be available if you do need to miss 1-2 sessions.)

Personal Information

*You may be as brief or in-depth as you like in your responses. Your responses will not be "evaluated" and there are no “wrong answers.”*

To the best of your knowledge, what is your ancestral / ethnic / cultural heritage(s)?

Is there anything else about your background, experience or identities that you would like us to know? (i.e. parent, adoptee, sexual orientation, gender identity, chronic illness, etc.)

What is your spiritual/religious background? Do you have a current practice in that tradition or any other spiritual practice?

Do you have a current practice of connecting with your ancestors or other spirits? Do you have experience in any ancestor-related practices?

Has anyone in your family or other parts of your life recently died (within the past year or two)?

Is there anything else you would like to share or that would be helpful for us to know?

Payment Information

Payment Method

Venmo: @elahzakarin (Do not select "Turn on for purchases" to avoid fee.)

PayPal: elahzakarin@gmail.com (Select Family & Friends Option to avoid fee.)

Zelle: elahzakarin@gmail.com

Other (if selecting other, please share what payment methods you are able to use in the comments section below)

How much will you pay?

If you are selecting the equity rate, please share the specific amount you will pay in the comments section below.

Standard Rate: $85 per session = $595 total

Equity Rate: $50-85 per session = $350-595 total *To account for the historical and ongoing realities of racism and colonization, the equity rate is offered for Black and Indigenous people and other People of Color (BIPOC) as well as those currently living outside of the US and anyone else who would not be able to access the standard rate.

Payment Timing

Total Payment made in advance of course

Two Payments: Half of total payment in advance of the first session and half before the fourth session

Other (if selecting other, please contact us directly to discuss other options.)

Do you have any questions or comments?

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