Blue Lotus Ceremony Application
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email Address *
Phone Number *
Social Accounts
Country *
In what city and state do you currently reside? *
Profession(s) *
Gender
Date of Birth *
Place of Birth (for astrology purposes)  *
Time of Birth (if known)
Time
:
Which courses have you taken thus far? *
Did you ever subscribe to our group mentorship? If so, which ones and for how long? *
Did you attend the Royal Egypt Retreat of 2024? *
Are you attending the Tarot Retreat September 22 2025? *
Are you part of the residing Local Ashland Sangha? *

Which other past retreats have you attended?

 *
Have you ever visited or stayed at the Sanctuary in Ashland? If so, how many times? *
Please share why you are interested in this transformational experience of the Blue Lotus Ceremony? (i.e. your intentions, any healing or transformation you are seeking) *
Tell us about your Spiritual or healing journey and any past spiritual training or skills you have cultivated? *
Have you experienced any plant medicines? If so, what type? *
Describe your current spiritual practice *

Medications & Supplements (please list)

 *
Any allergies or food sensitivities?

Dietary preferences

 *
Are you a smoker? *

Physical ailments (please list)

 *

Are you using any antidepressant medications?

 *
If so, please list which Anti Depressant(s) you are taking and for how long *

Have you ever been diagnosed with a physical, mental or emotional health condition?

 *
If so, what type of condition, what medications were taken, and for how long? *
What else do you feel is important for us to know about your medical health history (physical, mental and emotional)? *
Are you applying to attend the Blue Lotus Ceremony with a partner? If so,  please provide the name of the other potential attendee. *
What do you resonate most with in learning and receiving from Shekinah Ma and Sanandaji? *

Anything else you would like to share about your journey and inner calling?

 *
If you can not make it to the Blue Lotus Temple in February or March, would like to join a waiting list for later events?  *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Twinray.

Does this form look suspicious? Report

Google Forms