Micro CommUnity Program
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Email *
Name *
First and last name + Preferred Pronouns
Phone Number *
Tell me your goals and intentions for this program.
 *
Are you interested in Microdosing during this journey? If so, would you say you are sensitive to medicines? *
If you are interested in microdosing, it's important to know contraindications. 
What medications are you on? Have you had any history with or are you on any antidepressants and/or SSRIs?
 *
Are you interested in investing in 1:1 support with Liz? *
Are you interested in the work exchange position or scholarship?

A. Work exchange: I have knowledge and skill in social media, zoom, and backend tasks to support the group.

B. Scholarship: the price is a barrier to me, but I know I will be dedicated and am eager to start this journey for myself and those around me.

C. I am willing to pay full price ($700 if first 5, $800 after) knowing this will be an invaluable investment for me and my life and will create opportunities for others.
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Have you downloaded the Signal App? If not, please do so :)  *
A copy of your responses will be emailed to the address you provided.
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