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Name *
Phone Number *
Email *
Social Media Link (Personal Website, LinkedIn, Facebook, Etc). We want to learn about who you are! *
What work are you doing in the world? What drives you? *Please limit your response to 3 sentences or less.* *
What makes you excited about attending this event? *Please limit your response to 3 sentences or less.* *
What do you hope to learn from this event? *Please limit your response to 3 sentences or less.* *
Do you have experience with psychedelics? *
Cohorts will be formed for this event. Will you want to be in a BIPOC only breakout room? *
Is there anyone else you know who would benefit from attending this event? Please include their contact info here.
Is there anything that would help make this a more inclusive container and create a space where you feel comfortable to share your voice and perspective? *Please limit your response to 3 sentences or less.*
If you'd like to write anything additional about how you can best feel supported or share your hopes, dreams and visions, please feel free to write them here. *Please limit your response to 3 sentences or less.*
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