Men’s Retreat Application
Leavenworth, WA July 17-20, 2026
Basic Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What’s drawing you to this retreat right now?
*
What are you hoping to experience or shift during this time?
*
Briefly describe your experience (if any) with breathwork, somatic work, ritual work, or psychedelic/medicine spaces.
*
No experience is OK
What feels most supportive to you in a group of men?
*
e.g. structure, humor, depth, quiet, physical activity
What tends to be challenging for you in group settings?
*
This is a self-awareness question, not a disqualifier
Have you ever been diagnosed with or experienced any of the following? (Check all that apply)
*
Bipolar disorder
Psychosis or schizophrenia
Active suicidal ideation
Severe dissociation
None of the above
Other
Are you currently taking any medications or substances that might be relevant for us to know about?
*
Brief; details can be discussed on the call
Are you willing to participate in the required pre-retreat group Zoom, individual prep session, and post-retreat integration Zoom?
*
Yes
No
Is there anything else you feel is important for us to know as we consider fit?
When are generally the best times Monday - Friday to connect over the phone to talk next steps?
*
6-10 AM
10-2 PM
2-6 PM
Submit Application
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