Opulent Liberation Registration Form

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Name

Address

Tell me about how you identify, how you see yourself in the world.

Tell me about the transformation that you desire in this portal.

Tell me about pain you wish to transmute & a secret wish of yours.

Tell me about why you want to be in this circle.

Tell me what you visions you hold for yourself & what you see as your purpose.

Emergency contact?

Disabilities & Accommodation needs?

Dietary restrictions?

Vegetarian

Vegan

Kosher

Halal

Gluten-free

None

Other:

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If other, please elaborate below

If you attend the Celebration Circle in Hampton, Va you agree to share a room unless you make your own arrangements. Please acknowledge that below. You are also responsible for your transportation & all meals except for Dinner on Friday the 13th & Breakfast on Saturday the 14th. Please acknowledge that below.

I acknowledge that I will be sharing a room unless I make my own arrangements.

I acknowledge that I will be responsible for my transportation.

I acknowledge that I will be responsible for all meals except for Dinner on the 13th of December and breakfast on the 14th of December

Which payment plan do you choose?

$1111 Early Bird

$500 Early Bird spot RSVP

$1325 Regular Tuition

$750 regular spot RSVP

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Send me a copy of my responses.

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