Mother of Origin Retreat Application

1

NamePlease enter your full name

First Name

Last Name

2

EmailPlease enter your email

example@example.com

Email Verified

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Please check your mailbox and paste the code below to complete verification

••••

3

Instagram handle / Website (if applicable)Please enter your instagram / website (if applicable)

@example

4

Where in the world are you located?Drop your location and time zone

5

Have you participated in retreats or pilgrimages before? If so, where and what did you take from the experience?

6

Are you comfortable with deep emotional and spiritual work in a group setting?

7

Are you open to ceremony, mythic storytelling, and embodiment practices (movement, breathwork, sound, etc.)?

8

What does the Divine Feminine or Mother Archetype mean to you?

9

What specifically stood out to you or drew you to this container?

10

What kind of transformation are you hoping to experience or embody through this pilgrimage?

11

Do you have any physical limitations, health needs, or dietary restrictions we should be aware of for travel or walking portions?

12

Are you able to invest in yourself at this time?

Yes, I’m ready

I’d like to discuss a payment plan

Not yet, but I’m working toward it

Are you able or willing to use a credit card

13

How would you prefer to pay if accepted?

One-time payment

3 monthly payments

2 monthly payments

6 monthly payments

14

Would you prefer single or shared accommodations?

single

open to either

shared

15

Anything else you'd like to share with me? A prayer, a fear, a knowing?

16

Thank you for taking the time to fill out this form. We will be in touch.