Grass Valley Medicine Weekend
Name
E-mail
Phone number
Date of Birth
Have you worked with the medicine before?
Yes
No
This is my first time doing a medicine ceremony with Tat Erick.
Yes
No
If this is my first time in a medicine ceremony with Tat Erick, I must do a divination with him beforehand - contact HeddiL@gmail.com to arrange.
I understand
What are your plans for accommodations for this weekend? (We will be sending more information on options to stay and eat onsite to those that request it).
I will be returning home to sleep and coming for the each of the days, with the exception of the night of the medicine.
I would like to camp or car camp and will contribute to the extra meals - please send me more information.
I would like to sleep in the house and will contribute to the extra meals - please send me more information.
I would like to find lodging nearby.
What is your intention for this ceremony?
Medical Conditions
Any medications you take
Special Needs: (mobility, general issues etc.)
Dietary Restrictions/Food Allergies:
Emergency Contact information (name, e-mail, phone number)
Relationship of Emergency Contact (friend, spouse, parent, etc)
Submit
Should be Empty: