Program Application

Thank you for your interest in the Radical Human Connection 1 course with Greg Heffron.

Please fill out this online application. To save your entries, click Send when you are done.

Note: due to the potential for internet connection issues, you may want to write your answers elsewhere and copy/paste them into this form.

Your Full Name (required)

Your Email (required)

Your Phone Number (required)

Have you attended any of our programs in the past?
YesNo

Which program(s)? (location, approximate year)

If you have not attended any of our programs, will you complete The Five Keys to Mindful Communication 5-week recorded online course before the course begins on September 29?
YesNo

Have you read Susan Gillis Chapman's bookThe Five Keys to Mindful Communication?
YesNo

If your answer to the last question is NO, will you read it before the course begins on Sept 29?
YesNo

INTENTIONS

Please briefly tell us about your Intentions for the Course and why this approach is important to what you're doing in your work and personal life.

Is there anything else we should know?

Don't forget to click "Send." After clicking, scroll down a bit to see if it worked. You will also get an email confirmation with useful links.

Note that Green Zone Institute does not guarantee your acceptance to the course. Based on your application, we will decide on your entrance this year. We reserve the right to pass on any application for any reason. If we pass on your application, we may suggest further courses to take to increase chance of acceptance in future years.