Ignite Your Wild Medicine | Registration
Event Dates: January 2022 (refer to BosqueMedicineFarm.com)
Event Address: Earth Space PDX: 4135 SE Gladstone st
Sign in to Google to save your progress. Learn more
What is your name & pronouns? <3 *
Birthdate
MM
/
DD
/
YYYY
What is your email? *
How did you hear about Ignite Your Wild Medicine series?
Do you have any known allergies or dietary preferences / sensitivities? (i.e. gluten, alcohol, asters, honey, etc.) *
For in-class medicine making, tasting, etc.
Are you taking any medications or supplements?
Is there anything you'd like Jenny to know about you?
What is your relationship or experience of working with the living world (plants, fungi, land connection)?
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy