Dissociative Writers Subscription Name * First Name Last Name Email * Phone (###) ### #### WRITING 1. DW is a writing group for beginners, middlers, and experienced writers. Where do you place yourself on this continuum? 2. Do you currently write in a journal? 3. What other kinds of writing have you done? 4. Some of our workshops offer support and feedback. Are you ready to receive and give support and feedback? What will that look like for you? 5. What writing goals do you bring to Dissociative Writers? SAFETY (yours and others) 1. DW is a writing group, not a therapy group. Are you currently in therapy? 2. If not, do you have resources to help if you get triggered? 3. Are you willing to keep your video on during writers workshops unless you get triggered, in which case you can turn off your video or leave the workshop to take care of yourself? 4. DW strives to be a safe place for as many people as possible. What will help you feel safe in writers workshop? REFERRALS & RESOURCES 1. Were you referred to Dissociative Writers by a current or past subscriber? If so, please name them here so we can say thank you. 2. Are you involved with any other group or organization devoted to trauma or dissociative disorders? If so, please name them here so we can put them on our list of resources. HEARTBEAT Heartbeat Chat is the name of our community platform. Once you’ve submitted your subscription form, you will hear from our admin, Stephanie, who will welcome you to DW and offer an invitation to join our community platform, Heartbeat. Please accept the Heartbeat invitation so you can join our workshops and community. On Heartbeat, you will be asked to pay for your subscription, answer three “fun questions” to get to know each other, watch a welcome video, and agree to a code of conduct. Once that’s complete, you’ll be a full-fledged Dissociative Writer! PAYMENT The cost of maintaining Dissociative Writers is $10/monthly or $100/annually. This covers the cost of Zoom, Heartbeat, and Mailchimp subscriptions, insurance, administrative services, and other administrative costs. We do not ask for payment until you’ve joined us on the Heartbeat community platform where you will be asked to enter payment information via Stripe (bank account or credit/debit card). If you are unable to manage the full cost of DW, we are happy to cover that cost but ask that you make a one-time $10 donation to demonstrate your commitment. Please mark the method of payment below: $10/monthly recurring payment $100/annually recurring payment $10/one time donation Thank you for your interest in Dissociative Writers! Your safety and the safety of others is important to us, so we take some time to review each subscription form. We’ll be back to you soon, usually within 24 hours. Keep writing!
