"UnF*cked" - Beyond The Matrix Retreat
Date: October 1-6, 2025
Location: Secluded Jungle Retreat in Riviera Maya

Please fill out this form if you are interested in joining us for the retreat.  The retreat will be held at the beautiful and secluded Lunita Jungle Retreat Center in Riviera Maya.  Be ready for a life-changing week of rejuvenation, connection, and transformation.  

Sign in to Google to save your progress. Learn more
Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Time of Birth and Place of Birth *
What is your mailing address so we can send you some pre-retreat goodies? *
Phone Number *
Email *
Emergency Contact (Name and Number) *
Social Media Handle (optional)
What is your level of experience with yoga and meditation? *
Required
What is your level of experience with breathwork?  *
Required
What retreat experience have you had? *
What are you hoping to experience or learn during this retreat? *
We are tailoring this retreat to its participants.  1) Have you done plant medicine? 2) Would you be interested in a plant medicine ceremony? 3) If not, is it an issue for you if some group participants separate and partake in a ceremony one afternoon? (We would have other activities planned for those who are not wanting to do so) *
Dietary restrictions / Food allergies *
Limited spaces are available and filled on a first come, first serve basis.  What type of room are you requesting? (10% off if paid in full up front) *
If you are coming to the retreat solo, we try to match roommates intuitively and based on a questionnaire we will send you after you reserve your spot.  

If you are coming with a friend, write their name here if you are wanting to room together.
Where did you hear about this retreat from? (Feel free to reach out to any of us for more information!) *
Please share any concerns and/or questions you have about attending this retreat.   *
Is there anything else you would like us to know?
Please contact infinitehearthealing@gmail.com with any questions about the retreat or payment.  

We accept
1) Zelle (preferred) to 214-636-8278
2) Venmo to @InfiniteHeartHealing
3) Paypal to @InfiniteHeartHealing Click Here for Preset Paypal Payment Links
 *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms