Mito-Meno Retreat Application 
Thank you for taking the first step. Please know there are no "trick questions" here, and you do not need to write long essays or mask your reality. We ask these questions simply to ensure we can keep you biologically and physically safe. Take a deep breath. Bullet points are absolutely fine.
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Email *
Full Name (and what you like to be called) *
Phone Number (including country code for WhatsApp) *
Retreat Location and Month (eg, Kampot, Cambodia, Jan 27)
Which retreat experience are you applying for? *
How do you identify from a neurodivergent perspective? Formal diagnosis and self-diagnosis are both equally valid here. *
Required
What is drawing you to this retreat right now? What are your primary symptoms or struggles at the moment? (e.g., severe fatigue, sensory overwhelm, perimenopause symptoms. Bullet points are perfect—no need for full paragraphs *
Do you have any medical allergies or specific dietary requirements? Please include any severe allergies (e.g., nuts, celiac) as well as any sensory "safe foods" or aversions we should know about. We want to feed you beautifully without triggering your nervous system. *
Are there any physical or medical conditions we should know about to keep you safe? We ask this simply to ensure our environment and gentle movement practices can fully support your current physical capacity. *
Is there anything else you want Hannah or Rosa to know? You can leave this blank if you prefer.
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