What’s your First Name?
What's your email address?
(Please double-check you've entered it correctly!We won't be able to contact you if there's a typo.)
What's your date of birth? (Month Day, Year)
What's your gender?
What is your current occupation?
What is your phone number?
Please provide your current mailing address
Is there a specific problem you’d like to work
on during the retreat? If so, please
describe it here.
What do you hope to get from your retreat
Do you have any concerns regarding your retreat experience?
Have you ever used sacred plant medicines
What is your general level of comfort with
altered states of consciousness?
What is your bodyweight? (in Pounds/lbs)
(Entheogenic sacraments can interact with many prescription medications and herbal supplements. These interactions can be dangerous and/or reduce the subjective effects of the sacrament.To ensure your experience at a Heroic Path to Light retreat is safe and positive, it's very important to let us know about any and all medications you're taking.)
(These questions are personal so you do not have to respond if you do not feel comfortable; however, accurate answers to these questions help us create the most beneficial and safe retreat experience for everyone involved.)