::: kindred retreat registration ::: Name * First Name Last Name Email * Phone * (###) ### #### Home Address * Birth date * MM DD YYYY Birth time If known Hour Minute Second AM PM Birth place If known What practices and rituals are you devoted to in this season of your life? * Please share any dietary preferences, sensitivities and/or allergies: * Do you take any pharmaceutical medications? If so please list: * All information will be kept confidential What are the energies, emotions, patterns of relating to self and other that currently feel the most limiting to you? * Have you worked ceremoniously with sacred medicines and/or expanded states of consciousness? If so, please share: * Which of these archetypes are asking for your attention and care? * Child Maiden Mother Goddess Mystic Elder Other If you selected "other" please describe the archetype here: In a few words or sentences, please share what is calling you forth to this retreat: * Accommodation Request * Private room, king or queen bed: $3900 total, $1300 deposit Quad room, twin bunk bed: $2,100 total, $700 deposit Bell tent with bamboo floor mats: $1,200 total, $400 deposit Thank you!