Moving Rasa RetreatRegistration We’re so glad you can join us Name * First Name Last Name Pronouns * Email * Best Contact Number (###) ### #### Please share how you heard about this event. If an organization or collective shared it with you, please offer their name. Tell us about your experience with somatic practices and improvisation: Tell us about your experience with anti-racism and social justice work: Is there anything else you would like to share? Please confirm that you can make all dates and times during the Retreat. If you are unable to attend the whole time, please share your schedule in the following section. We prioritize those who can make the whole time. * I can make all the sessions. Other - please share more info below. If you can't join for all the sessions, let us know more here: Some food-sharing will take place at the retreat. Do you have any dietary restrictions or sensitivity? Vegan Vegetarian Pescatarian Gluten-free Dairy-free No seafood No red meat No pork Other - please share below Please share any other dietary needs here: Do you have any access realities that we can do our best as a community to accomodate? (ie. physical like wheelchair accessibility, or social like hypersensitivities around police.) Please share here if you have allergies, or if you have any particular needs around lodging as well! The following section will ask for your demographic information. This section is optional, and any information you share with us will be kept confidential. The aggregate datas will be used for the purpose of reporting and and grant application. We are excited to offer this workshop to the AANHPI community! Please indicate your diaspora ethnicity(ies). If you have more than one ethnicity, please share additional information in the next question. Afghanistan Armenia Artsakh Azerbaijan Bahrain Bangledesh Bhutan Brunei Burma Cambodia China Cyprus Georgia Hong Kong India Indonesian Iran Iraq Japan Jordan Kazakhstan Kuwait Kyrgyzstan Laos Lebanon Malaysia Maldives Mongolia Nepal North Korea Oman Pakistan Palestine Philippines Qatar Saudi Arabia Singapore South Korea Sri Lanka Syria Taiwan Tajikistan Thailand Tibet Timor-Leste Turkey Turkmenistan United Arab Emirates Uzbekistan Vietnam Xinjiang Yemen Other (Please specify below) Please share your gender identification: Female, femme, transfeminine Male, masc, transmasculine Non-binary, gender fluid, or non-conforming Gender unknown, or prefer not to say Other (Please specify below) Please share anything else that you wish for us to know about your identity (age, ability, sexuality, income, etc): Is there anything else you would like to tell us? (If you have not been exposed to Moving Rasa, this is an important space for you to share more about why this workshop is of interest to you and what your background experience is.) Thank you for responses. We will review your application and send confirmation by the end of this month, if not sooner. Follow us @moving.rasa on IG. Learn more at www.movingrasa.com Thank you so much for registering for our upcoming Moving Rasa Retreat. We look forward to connecting with you.If you have any questions, please feel free to reach out at info@movingrasa.com