Journey of Awakening Retreat Application 

Please fill out this application as completely and truthfully as possible. 

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Email *
Full Name *
Preferred Name
Date of Birth
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Email *
Phone Number *
Where are you based? (City/Town)  *
What is your current occupation? *
Do you have any previous experience with transformational retreats, such as yoga, meditation, or plant medicine?  *
Do you have any previous experience with expansive states of consciousness, such as those brought about by meditation, intense breathwork, NDE’s, kundalini,  psychedelics, etc? Please explain.  *
Why do you want to attend this retreat?  What interests or excites you about the experience? *
Please describe spiritual, therapeutic or mindful practices you engage with including modalities you have studied or traditions you align with:   *

Do you have any mental illness or related conditions that you feel might limit your full participation in the retreat? Please list any clinical diagnosis, medications, or acute issues currently in the process of working through.  (This information is confidential and will help us to better serve you. Note: A separate mental health contraindication & trauma screening will be provided to ensure fitness for the trip).

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Who referred you to the retreat / How did you hear about this retreat? 

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The fee for the Journey of Awakening is $2250 with a full payment due by 10/10. 

The deposit for the Journey of Awakening is $1000, due upon completion & acceptance of application and wellness intake. 
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Required
What payment method do you intend on using for the Journey of Awakening Experience?

Note: Please mark coaching or retreat in the Notes section for payment.  *
Required
To ensure your safety and readiness, Do you understand that acceptance into the Journey of the Awakening retreat will be determined upon completion of the Wellness Assessment to follow this application? *
Required
Is there anything else that you would like for us to know in considering your application? *
Please type your full name in CAPITAL letters to certify that your responses above are true and accurate. *
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