A Return to Self Ayahuasca Immersive
Welcome to the application form and health screening for the Return to Self Ayahuasca Immersive! Please fill out all sections of the form to the best of your ability and answer all questions honestly. Once we receive your submitted form, expect an e-mail from Alex or Mitchell within 24-48 hours setting up a time for your intro call!
Much Love, <3 Alex & Mitchell
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Email *
What is your full legal name? *
What is the best phone number to reach you at? *
How did you hear about us? *
If someone referred you, what is their name? *
Which week of the retreat are you interested in? (2023)
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