Workshop

Thank you for deciding to register for this virtual workshop.

Saturday, April 17th @ 1:00 pm
Name *

First Name Last Name
E-mail *
Do you live in Kentucky? *

Yes No
Thank you for your interest in this workshop. We would love to have you attend our virtual workshop.

Unfortunately at this time, we will not be able to ship the free bonus that will accompany this workshop, out-of-state.

We are so sorry about that, however, if you would still like to attend please continue filling out the form. We would love to have you!
Please consider answering the following questions to help us fund future workshops. Feel free to answer only what you are comfortable sharing. All submissions are confidential.
How did you hear about the workshop?

Social media Friend/Colleague Newsletter
Would you like to receive emails in the future about workshops, groups, and other programs that Ampersand is providing?

Yes No Unsure
How would you describe the sexual trauma you have experienced? Please select all that apply.

Sexual Harassment Rape or sexual assault Childhood sexual abuse Intimate partner, dating or domestic violence Stalking Human trafficking Other type of sexual trauma not listed
Thank you for taking the time to complete this form. We know it can be difficult. Please call our 24/7 support line @ (859) 253-2511 to connect with a trained advocate if extra support around your sexual trauma is needed. We are here for you.

If you have any additional questions pertaining to the workshop please email or call Vanessa @ vcortez@ampersandky.org or at (859) 625-0213 during the business hours of 9am-5pm.
Once this form has been fully submitted, you should have received an email with a Zoom link for the workshop. If you did not receive an email with that link after submitting this form contact vcortez@ampersandky.org.
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Thank you for deciding to register for this virtual workshop.