Sexual Healing, Plant Medicines & Mother Earth
A 7-Day Retreat in Costa Rica : April 14-20, 2023

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Please choose your preferred accommodations/see pics & description of choices at:  https://synergycostarica.com/accommodations/

* Master Suite w/Private Balcony/King Bed/shared kitchen for 2 people @ $4950/per person 
* Luxury Cottage Suite w/Private bath & kitchenette for 2 people @$3950 per person 
* Queen Suites w/private bath & private deck @$3950 for 1 person 
* Lotus Room w/Full Bed + Shared bath @$3750 per person
* Bamboo Room w/shared kitchen and lounge as Master Suite for 2 singles @ $3450 each or 1 couple @3750/per person
* Kogi Temple w/2 beds and shared bath steps outside of temple for 2 singles @$3450 each or 1 couple @$3750 per person
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What is your name and contact email?  *
What are your intentions in applying for this retreat? 
What is your experience with sexual healing: therapeutically, somatically, transgenerationally, etc? 
What is your experience with Plant & Psychedelic medicines: micro-dosing, hero's dosing, ceremonies, etc. ?   Please include the approximate # of ceremonies you've sat in, with which medicines, and for how many years.  
What is your experience/training as a therapist, practitioner and/or bodyworker?  Please include any certifications and trainings.  
Are you aware of any past traumas that may be present in your embodiment? 
Have you ever experienced physical, sexual, emotional or verbal abuse? 
Have you ever experienced unwanted sexual contact, physical touch, or penetration? 
Do you understand and acknowledge that the nature of the retreat experiences involves giving and receiving facilitated sexual dearmouring practices?   
If you are applying as a couple, do you understand and acknowledge that you are at choice as to whether you want to give and receive facilitated sexual dearmouring practices with each other or with other participants? 
Do you have any concerns about your capacity to voice your body's boundaries and consent? 
Are you on any medications?  If so, please list them here. 
Do you have any physical ailments or issues that may be a factor in your participation of somatic body-based practices? 
Have you ever received a psychiatric diagnosis of any kind or been admitted for treatment to a psychiatric facility that would warrant a conversation about participation? 
Do you have any questions you would like to ask? If yes, please feel free to do so here.  Thanks very much.  
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