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Thank you for signing up for an event with us. We have some questions for you, so that we can get to know you better to support you during your journey in the best way possible.

First name *

Last name *

Company

Email *

Phone *

Date of birth (dd-mm-yyyy) *

Streetname + number *

Zipcode *

City *

Do you have experience with psychedelics? *SelectYesNo

If so, which and when was the last time? *

How has/have your experience(s) been with psychedelics? *

How sensitive are you to alcohol and/or mind-altering drugs? *

Do you ever use mind-altering drugs?SelectYesNo

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What is the reason you are registering for this retreat? *

What would you like to know, find out, learn, process? *

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Other: *

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• I have answered the above questions truthfully.

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