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FireKeepers at the Crossroads
September 22 to 25, 2022
Thursday, 10 am to Sunday, 12 pm
Please arrive by 9:15 am for check in
Contact us at (360) 320-5343 or
nwsoulquest@gmail.com
We hold all responses below in confidentiality.
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Email
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Name
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Address
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Telephone number (Cell or landline?)
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Birthdate (optional)
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Pronoun Preference
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This experiential program may catalyze deep inner work. Tell us very briefly about your background in doing inner work (including healing trauma).
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Health or Medical Issues or accessibility needs you want us to be aware of
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Are your COVID vaccinations up to date?
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Are you currently taking any prescription, over-the-counter medications, or recreational drugs? If so, please list and indicate reason for taking.
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Who to notify in case of illness or injury and their contact info (Phone, Text, etc.)
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Any food restrictions? Use "Other" for multiple restrictions, and note what they are. We'll let you know if we can accommodate them.
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Vegetarian
Vegan
Dairy-free
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Other:
What fee do you intend to pay?
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$325
$495
$675
Other:
How are you sending your $200 Deposit
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Deposit by snail mail (payable to Anne Hayden, PO Box 181, Clinton, WA 98236)
Deposit by PayPal (send to:
nwsoulquest@gmail.com
) (Please add 3% PayPal fee)
Deposit via Zelle (use
nwsoulquest@gmail.com
as payee)
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