Membership Registration - Work That Reconnects Network

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Membership Level change

You have selected the Facilitator Members membership level.

The suggested sliding scale for your annual Facilitator Membership fee is $75-$200 USD. Please consider your location within the global economy and contribute generously within your means.

If you require a lower annual membership fee you can enter an amount equal to or greater than $25 USD. If you are unable to make an annual payment, please contact us at admin@workthatreconnects.org to request a full waiver. Waived memberships will be valid for one year, after which we will check in with you to see what makes sense for you at that time.

Please note that your card will be charged when you submit this form. If this is your first time applying for Facilitator Membership and your application is not accepted we will issue a full refund.

Enter a price between $25.00 and $200.00.

Your price: $

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Members

First Name

Last Name

Email Address

Email (This is only for WTR Network staff use. Your email will not be displayed in your profile unless you choose that option below)*

Pronoun

she/hers

he/him

they/theirs

prefer not to say

other

Other Pronoun

Country of Residence

State or province

City or town

Bio

Profile header image

Background image

Primary Language

Other Pronoun

Primary Language

Other languages you speak (select all that apply)

Bengali
Chinese
Danish
Dutch
English
French
German
Hebrew
Hindi
Italian
Japanese
Korean
Lebanese
Malay
Persian
Portuguese
Punjabi
Quechua
Romanian
Russian
Spanish
Swedish
Tagalog
Taiwanese
Thai
Urdu
Vietnamese
Other

Other Language

Contact information to be displayed on your facilitator profile for the public to see. (Please choose one or more)

Email
Phone
Website (if you chose website)
Social Media
Contact me through WTR Network Forum
Other

Email Address (if you chose email)

Phone Number (if you chose phone)

Website (if you chose website)

Facebook

Twitter

Intagram

Social Media - Other 1

Social Media - Other 2

Contact me through WTR Network Forum

Other - Contact information

Facilitator Members Information

Please note that the Facilitator Membership requires approval of the application below based on the criteria listed at www.workthatreconnects.org/facilitator-member-application/ Please review the criteria before completing this application. If you have already submitted your application, it may be pending approval. Please do not resubmit. If you haven’t heard from us yet or you have questions please email us at admin@workthatreconnects.org

Statement of Purpose & Philosophy

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Why I am called to facilitate the Work That Reconnects

(25-100 words)

How I see the Work That Reconnects serving the Great Turning

(25-100 words)

Experience & Training

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This section will capture your experience as a participant of the WTR along with your relevant training and background as a facilitator.

WTR Workshops you have experienced as a participant. Please note that the minimum requirement to be listed as a Facilitator Member with the WTR Network is 18 hours as a participant in full spiral WTR events. (if you started long time ago, please enter a few of your most memorable experiences)

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Workshop 1 - Name

Workshop 1 - Year

Workshop 1 - Facilitated by

Workshop 1 - # hours

Workshop 2 - Name

Workshop 2 - Year

Workshop 2 - Facilitated by

Workshop 2 - # hours

Workshop 3 - Name

Workshop 3 - Year

Workshop 3 - Facilitated by

Workshop 3 - # hours

Workshop 4 - Name

Workshop 4 - Year

Workshop 4 - Facilitated by

Workshop 4 - # hours

Have you graduated from a facilitator training program? This is not a requirement for being listed, but can be a nice thing to share if you have attended one. Please select all that apply:

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If you responded "other" above, please list the program(s) you took here, along with their facilitators and location:

Other relevant skills and experiences you bring to your WTR facilitation

Anti-oppression and Decolonization

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Please add any experience or training you have had in the last 10-15 years in anti-racism, undoing oppression, decolonization, etc. If you have had none, please type "none" into the first cell of the table.*

Training 1 - Name of the training

Training 1 - Facilitated by

Training 1 - Year

Training 1 - #hours

Training 2 - Name of the training

Training 2 - Facilitated by

Training 2 - Year

Training 2 - #hours

Training 3 - Name of the training

Training 3 - Facilitated by

Training 3 - Year

Training 3 - #hours

Facilitation skills

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Please add any notable experience or training you have had in the last 10-15 years in facilitation of groups, group dynamics, online facilitation, etc. If you have had none, please type "none" into the first cell of the table.*

Training 1 - Name of the training

Training 1 - Facilitated by

Training 1 - Year

Training 1 - #hours

Training 2 - Name of the training

Training 2 - Facilitated by

Training 2 - Year

Training 2 - #hours

Training 3 - Name of the training

Training 3 - Facilitated by

Training 3 - Year

Training 3 - #hours

Trauma-informed training or experience

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Please add any notable experience or training you have had in the last 5-10 years on trauma-informed facilitation or interventions. If you have had none, please type "none" into the first cell of the table.*

Training 1 - Name of the training

Training 1 - Facilitated by

Training 1 - Year

Training 1 - #hours

Training 2 - Name of the training

Training 2 - Facilitated by

Training 2 - Year

Training 2 - #hours

Training 3 - Name of the training

Training 3 - Facilitated by

Training 3 - Year

Training 3 - #hours

Experience facilitating WTR events & workshops

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In what year did you begin facilitating the Work That Reconnects?

Work That Reconnects workshops you have facilitated

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Please note that the minimum requirement to be listed as a Facilitator Member with the WTR Network is 12 hours (2 workshops) as a facilitator for full spiral WTR events. *

Workshop 1 - Name

Workshop 1 - Year

Workshop 1 - Co-facilitator name

Workshop 1 - #hours

Workshop 2 - Name

Workshop 2 - Year

Workshop 2 - Co-facilitator name

Workshop 2 - #hours

Workshop 3 - Name

Workshop 3 - Year

Workshop 3 - Co-facilitator name

Workshop 3 - #hours

Workshop 4 - Name

Workshop 4 - Year

Workshop 4 - Co-facilitator name

Workshop 4 - #hours

Experience facilitating other events & workshops

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Please add details here:

Preferences

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Are you willing to be a mentor for new WTR facilitators?*

Yes

Maybe

Have you graduated from a facilitator training program?

Spiral Journey Facilitator Development Program (global, online)
Holon Training (Europe)
Entrenamiento para facilitadores del TQR (Spanish, online)
Facilitator Development Adventure
Other

Audiences you work with (select all that apply)

Children
Youth
Parents
Elders
Women
Men
LGTBQ
Business
Academic
Government
Activists
Interfaith
Refugees and Immigrants
Other

Other

Payment Information We accept all major credit cards

Card Number

Expiration Date

CVC

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