Name *

First Name

Last Name

What time zone are you located in? *

Pacific Standard Time

Mountain Time

Central Standard Time

Eastern Standard Time

Other

Why are you interested in joining this 6 week program? *

improve mental health

get deeper into flow state

enhance creativity

navigate through a difficult life event

learn how to microdose for the first time

connect with others who microdose

create a more intentional relationship with microdosing

learn Indigenous traditions around microdosing

create a deeper relationship with psilocybin

just curious

Please confirm that you understand, agree and consent to the following by marking each box. *

I have truthfully answered all of the questions in this form.

I understand that Vibrational Healing is not responsible for the inappropriate use of microdoses, nor for the consequences that could be incurred by this practice

I understand that registration to this course does not include medicine or microdoses of medicine.

I take responsibility for sourcing my own medicine.

While one of the facilitators for this program is an LMSW, I understand that microdosing mushrooms and this program is not a substitute for therapy.

I understand that space is limited and my application will need to be approved before my spot is confirmed.

In the case that my application is confirmed, I understand that the price of this program is $555USD and my payment will ensure that my spot is reserved.