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Psilocybin Retreat Application
Please note, not every applicant may be accommodated due to limited space. Those selected must successfully pass our safety screening and intake process in order to attend.
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1
Name
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What is your name?
First Name
Last Name
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2
Email
*
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What is your email address?
example@example.com
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3
What is your prior experience with psychedelics (psilocybin or otherwise)?
*
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Please share why you would like to attend this retreat specifically, why now, and what you are hoping to gain.
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4
What is your motivation for attending this retreat?
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Please share why you would like to attend this retreat specifically, why now, and what you are hoping to gain.
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5
Anything Else
Is there anything else you would like us to know?
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6
Which of the following best describes your level of interest for the retreat?
*
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I am highly interested and ready to pay
I am highly interested but would want to learn more first
I am curious but am not sure I’m ready to commit
I am highly interested but would need financial assistance
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7
Center Location
Please Select
Retreat
Retreat
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Retreat
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