Retreat Registration

Mexico Psilocybin Retreat

Application
This application helps us understand who you are, where you're at, and whether this retreat is the right fit for you right now. There are no wrong answers — only honest ones. All information is kept strictly confidential.
Full Name
First NameLast Name
Address
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date

Experience and Background
Have you worked with psilocybin or other plant medicines before?
Do you have any current mental health support? (therapist, psychiatrist, spiritual advisor, coach, etc.)

Health and Safety
Do any of the following apply to you? (Check all that apply)
Please list any medications, supplements, or health conditions you'd like us to know about:
Do you have any dietary restrictions or food allergies?

Logistics
How did you hear about this retreat?
Is there anything else you'd like us to know before we connect?
By submitting this application, you confirm that you are 21 years of age or older and that the information provided is truthful to the best of your knowledge. Submission does not guarantee a spot —I will follow up within 3–5 business days.
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Mexico Psilocybin Retreat