Gathering Application & Deposit Form
Our time together will enable you to take a reprieve from the professional and personal demands of your everyday life to experience regenerative immersive experiences and gatherings
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Tell me a little bit about yourself
*
Why are you drawn to a Self-Mothering experience?
*
In what ways does the idea of being cared for in the company of other women appeal to you?
How did you hear about us?
Social media
Google search
Current client
Referred by someone
Other
Anything you want to add?
What is your deposit for?
Fall 2025 (Oct 30 - Nov 4) - Dia De Los Muertos in Mexico
Spring 2026 (March 16 - 21) - Self-Mothering in Mexico
Summer 2026 (July 19 - 26) - Self-Mothering in Ireland
VIP Regenerative Immersive Experience
Flexible payment options to distribute payments over time. Would you like to learn more about flexible payment arrangements?
Please Select
Yes, I would like to learn more about flexible payment options
Maybe, I'm still weighing my options for payment
No, I intend to pay the remainder of the balance, in full, upon my selection
My Products
*
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Deposit - Immersive Experience/Gathering
$
400.00
This deposit will secure your spot! If for some reason your application is not accepted, your deposit will be refunded within 24 hours.
Total
$
0.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Please verify that you are human
*
Secure my spot!
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