First Name

Last Name

Phone *

Email *

What Activities Have You Lose Track of Time? 1543s *

A) Reading a good book

B) Gardening or working outdoors

C) Socializing with friends or family

D) Working on a hobby or craft

F) Exercising or playing sports

G) Cooking or baking

H) Traveling and exploring new places

I) Learning new skills or hobbies

J) Playing games (board games, card games, etc.)

K) Watching movies or TV shows

L) Listening to or playing music

M) Practicing mindfulness or meditation

N) Engaging in DIY projects or home improvement

O) Writing (journaling, poetry, stories, your memoir or novel)

P) Photography or videography

Q) Teaching or mentoring others

R) Participating in community events

S) Engaging in political or social activism

T) Caring for animals

What Type of Environments Energize You? *

A) A quiet room with a good book or puzzle

B) A garden or park with plenty of greenery

C) A lively gathering with lots of conversation

D) A workshop or studio where I feel inspired to create

E) A community center or volunteer organization

F) A gym or sports field

G) A kitchen filled with delicious smells

H) A new city or country with different cultures

I) A classroom or training session

J) A game night with friends or family

K) A cozy living room with a great movie

L) A music venue or practice space

M) A serene space for meditation or yoga

N) A hardware store or home improvement store

O) A quiet space with a notebook and pen

P) An outdoor location with great photo opportunities

Q) A classroom or workshop where I can teach

R) A community hall or event space

S) A rally or protest (part of a crowd with a mission)

T) A Nature Preserve or other wild spaces with animals

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