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Phone Number
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Email
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Social Media Link (Personal Website, LinkedIn, Facebook, Etc). We want to learn about who you are!
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What work are you doing in the world? What drives you? *Please limit your response to 3 sentences or less.*
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What makes you excited about attending this event? *Please limit your response to 3 sentences or less.*
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What do you hope to learn from this event? *Please limit your response to 3 sentences or less.*
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Do you have experience with psychedelics?
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Cohorts will be formed for this event. Will you want to be in a BIPOC only breakout room?
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I want to be in a BIPOC only breakout room.
I feel good being randomly put in any breakout room.
I am open to both a BIPOC only breakout room or being randomly put in a breakout room.
Is there anyone else you know who would benefit from attending this event? Please include their contact info here.
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Is there anything that would help make this a more inclusive container and create a space where you feel comfortable to share your voice and perspective? *Please limit your response to 3 sentences or less.*
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If you'd like to write anything additional about how you can best feel supported or share your hopes, dreams and visions, please feel free to write them here. *Please limit your response to 3 sentences or less.*
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