Retreat Application

Please answer all the questions to the best of your ability.

Personal Information (* required)

* Name:

* Address:

Telephone:

* Email:

Occupation:

* Date of Birth:

Languages:

* Emergency Contacts with phone numbers (2 minimum):

Inquiry:

What would you consider to be most important to you in life?

What are you aiming to get out of your participation in this retreat?
What are you willing to put on the line to get it?

How would you describe your health?
Are you moving toward or away from wellness?

What kind of exercise or any other healthy habits do you engage in?

What are your unhealthy habits?
Are you working towards giving them up?

What is your quality and quantity of sleep?
Do you remmember your dreams?
Do you experience lucidity in dreams?

Do you have any physical injuries?

What would you consider to be your biggest fears in life?
Are you willing to face them?

Are you able to recognize recurring patterns or habits in your life?
Are you working to overcome those patterns?

Are you currently in a personal relationship? Extrapolate.
What was the quality of your past relationships?

Choose five adjectives to describe yourself:

What inspires you most in life?
Are you currently living in line with that inspiration?

Are you affiliated with any religion or spiritual discipline?
If yes, please explain in detail.
If no, what is your current path in life?

Do you have any knowledge or experience with:
Shamanism
Yoga and Meditation
Landmark Education
Alternative Healing
Other (Please describe in detail)

Have you ever explored the use of psychotropic substances or plants?
Which ones? What was your experience like?

Anything else you would like to add?

Thank you for taking your time to answer the questions.
Hit SUBMIT button below. On the confirmation page, hit CONTINUE.