Medicine Weekend & Vision Quest Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Answering these questions will help us design better experience for you!

Email *

Your Name *

Your Cell Phone Number (for texts or emergency only) *

Emergency Contact Name, Relationship, & Phone Number *

Please share with me, from the heart, your reasons for wanting to join me in this weekend of spiritual ceremony? (Provide as much info as you can - I use this when I tune in spiritually to your energy). *

Please share the top 2-4 fears, limiting thoughts/beliefs, or actions that you would like to release and give over to the Divine? (We will work with these in the ceremony itself). Be thorough. *

Please list your top 3-4 most relevant intentions for what you would like to manifest in your life? (we will use this in our preparation and support work and will discuss this in our pre-weekend zoom call) *

How would you likely arrive in Flagstaff? *

Flying into Phoenix & take Groome Shuttle to Flagstaff (2.5 hrs)

Flying into Flagstaff

Driving my own vehicle (or with someone else)

Other (please explain in comments below)

Other:

Please describe your relationship to a fear of heights. There may be several places (in Sedona only) that will require to you hike up a fairly steep incline. Please acknowledge that you accept the risk (& know that we will do our best to accomodate your body's abilities and any fears of heights). *

Do you have special dietary restrictions? Please list here things to avoid. I, Michael, will provide two very simple meals each full day - likely a breakfast and a dinner. We can buy groceries upon your arrival. *

Please list anything I should be aware of in regard to keeping you safe, such as physical limitations, disability, illness, important medications that you need, and/or ALLERGIES: (I will have you sign a waiver of liability prior to the event). *

Please enter your sun, moon, and rising signs (if you know them). If you don't know this, simply give me month-day-and year of birth, along with location of birth (& exact time only if you know it). If you are accepted, I will create an astrological chart for you. Astrology helps me understand your design (& I can share more later). *

Based on what you know right now, what are you most looking forward to during this weekend?

Please check the box below to acknowledge you agree with the following: 1) Because of my commitment, there are no refunds, and 2) I agree to follow Michael's specific instructions as to how to prepare myself energetically and spiritually for TWO WEEKS PRIOR to arriving for the weekend. 3) If accepted, I agree to immediately make payment, within 24 hours, to reserve my spot. Payments can be split into two monthly payments if needed.
*

I agree to the terms. I will prepare myself prior to the weekend & pay upon acceptance.

Required

Any other comments (or things I should know?)

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms