Join Deva Haven

1

Which dates are you registering for?

Please fill out a separate form for each ceremony that you are attending

2

Legal Name* This field is required.Please enter your legal first and last names

First Name

Last Name

3

Preferred Name* This field is required.Please tell us how you would like us to refer to you

First Name

Last Name

4

Email* This field is required.Please enter your email address

example@example.com

5

Phone Number* This field is required.

Please enter a valid phone number.

6

Emergency Contact* This field is required.Please enter the legal first and last name of an emergency contact. Emergency Contact cannot be someone else who will be attending this gathering.

First Name

Last Name

7

Please enter your emergency contact's phone number* This field is required.

Please enter a valid phone number.

8

Do you have experience with Grandmother medicine?* This field is required.

YESNO

9

Do you have experience with Kambô medicine?* This field is required.(Kambô is not scheduled to be served at all gatherings, but sometimes unplanned opportunities present)

YESNO

10

Do you have experience with Rapé?* This field is required.

YESNO

11

Do you have experience with Cacao?* This field is required.

YESNO

12

Do you have experience with Sananga?* This field is required.

YESNO

13

Do you have experience with Blue Lotus?* This field is required.(Blue Lotus is not served at most gatherings, but unplanned opportunities do present)

YESNO

14

Have you attended one of Etheric's/Deva Haven's previous gatherings?* This field is required.

YESNO

15

Are you willing to commit to the pre-ceremony diet before entering ceremony?* This field is required.If you have not read the "Preparation" page of the website, please do so now.

16

Please write out any specific health diagnoses, concerns, or needs that you have.* This field is required.Please disclose any medical diagnoses whether you think they are important or not. Please also list here any food or herb allergies that you might have.

17

Are you currently taking any prescription medications or supplements?* This field is required.If so, please list them here. Your honesty = our safety.

18

What is your intention with attending this ceremony?* This field is required.Please be specific.

19

The next step is submitting your deposit to reserve your spot! Please send your deposit to @highvibes on Venmo, or $crystalchildvibes on CashApp (as friends and family, or else we will need to charge tax as well). Once completed, Etheric will contact you to schedule a pre-ceremony consultation phone call. Below, please write: the platform you sent your donation on, the account name it was sent from, and the days of the week that are generally best for you to have a consultation. Please contact one of us directly if you need to use a different payment method. Click the submit button below only after these last steps have been completed, and your spot for ceremony will officially be reserved!