ONE NIGHT: Friday, May 3, 2024

$295.00

Not available (Option fully booked at this time)

Category:

Participant Information

Have you ever sat in ceremony with us before? *
Have you taken any antidepressant or antihypertensive medications in the last six months? *
Are you taking any prescription medications or have you taken any prescription medications in the last two months? *
Are you currently dealing with an active addiction to any of the following substances: alcohol, benzodiazepines, cocaine, heroin, methamphetamine, opiate medications, or any other substances?(Please note this information is kept private and confidential.) *
Have you ever had gastric bypass surgery? *
Are you pregnant, or do you think you could be? *
Diagnosed or undiagnosed, have you ever had any issues with the following mental-health conditions: Bipolar Disorder, Borderline Personality Disorder, Dissociative Identity Disorder, Schizophrenia or Schizoaffective Disorder? *
I understand that I will be asked to fill out a Health Form and Questionnaire and that I must provide this information in a timely fashion in order to maintain my ceremony reservation. *
I understand that I may be contacted if more information is needed. If for any reason we decline your registration, your donation will be promptly refunded. *
I understand that taking pictures, filming, or any type of recording, without permission, is not allowed during the course of the ceremony weekend. *
I understand that my ceremony donation is non-refundable, and that registrations declined by us will be promptly refunded. *
I promise to review the A.Y.A. Ceremony Preparation Guidelines and to prepare my body, mind, and spirit to participate in the sacred space of ceremony. *

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