Women Rising Retreat Application Form

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Women Rising Retreat Application Form

Thank you for your interest in the Women's Plant Medicine Retreat in Portugal.

Please fill in the detail below and one of our facilitators will be in touch with you via email.

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* Indicates required question

Email *

Your email

Name *

Your answer

City, Country of Residance *

Your answer

Birthday *

MM

/

DD

/

YYYY

Phone Number *

Your answer

Are you currently taking anti-depressants (SSRIs)? *

Your answer

What is your primary motivation for doing the retreat? *

Your answer

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