THE UNBINDING FOR PROVIDERS

REGISTRATION

October 12–13, 2026 | Oklahoma City

I'm excited you're considering joining the first Provider cohort.

Before you complete your registration, I'd like to learn a little about you and make sure The Unbinding is the right fit for where you are right now.

Once your registration and deposit are complete, your place will be reserved and I'll guide you through everything else one step at a time.

Your retreat starts before you arrive.

Let's begin.

ABOUT YOU

First name

Last name

Email

Phone

Preferred Method of Contact

Email

Call

Text

YOUR PROFESSIONAL WORK

Tell me a little about the human behind the provider.

What's your current professional role? (LPC, LCSW, LMFT, psychologist, behavioral health consultant, counselor, social worker, student/intern, other helping professional.)

Where do you currently work or practice?

How long have you worked in a helping profession?

Are you seeking continuing education credit for this experience?*

Yes

No

I'm not sure

WHY THE UNBINDING?

You spend a lot of time paying attention to other people.

For these next few questions, turn that curiosity toward yourself.

What made you interested in The Unbinding for Providers?*

What would you most like to receive from this experience? (This might be personal growth, reconnection, rest, greater awareness of your own patterns, professional reflection, community, renewed connection to your work—or something entirely different.)*

Is there anything currently happening in your life that may affect your ability to participate fully in the online journey, consultations, or two-day retreat? (You don't need to disclose personal information you don't want to share.)

PARTICIPATION & READINESS

The Unbinding is more than a two-day retreat.

Your experience includes an online journey, personal reflection, individual and group consultations, the retreat, and post-retreat integration.

Are you willing to engage in personal reflection about your own experiences, beliefs, patterns, relationships, and ways of living?*

Yes

I have some questions or concerns I'd like to discuss first

Are you able to attend both retreat days in full?* Monday, October 12 and Tuesday, October 13, 2026 9:00 AM–4:00 PM Oklahoma City

Yes

I need to discuss a scheduling concern before registering

Are you willing to complete the required online journey and participate in the consultations associated with the experience?*

Yes

I have questions before committing

HOW WE'LL WORK TOGETHER

The Unbinding for Providers is an educational and developmental experience—not therapy.

Personal reflection is an important part of the experience, but you remain in control of what you choose to share.

Throughout the experience, we'll spend time learning, reflecting, practicing, and integrating.

Please confirm each statement:*

I understand this is an educational and developmental experience, not therapy.

I understand personal reflection is part of the experience and I remain in control of what I choose to share.

I understand participation includes the online journey, consultations, and retreat experience.

I understand respectful participation and confidentiality are expected.

YOUR INVESTMENT

Founding Cohort Investment $1,500

Today's $300 deposit reserves your place and is applied toward your total investment.

After your registration is complete, you'll choose one of the following options to complete your remaining balance.

• Pay in Full — $1,200

• 4 Payments — $300

• 6 Payments — $200

• 8 Payments — $150

The Unbinding Deposit

$300

THE UNBINDING FOR PROVIDERS

REGISTRATION

October 12–13, 2026 | Oklahoma City

ABOUT YOU

YOUR PROFESSIONAL WORK

WHY THE UNBINDING?

PARTICIPATION & READINESS

HOW WE'LL WORK TOGETHER

YOUR INVESTMENT

Founding Cohort Investment $1,500

Choose your pricing plan

8-Week Payment Plan

6-Week Payment Plan

4-Week Payment Plan

Pay In Full