JOURNEY REGISTRATION

Begin With Honesty, Care & Intention.

This registration helps our team review medications, health considerations, logistics, support, and readiness before confirming participation.

Private submission: Your answers are stored inside WordPress and are visible only to authorized site administrators. Internal notification emails contain a brief summary and a secure admin link, not your complete health responses.

SELECT ONE

Which journey are you applying for?

N,N-DMT JOURNEY Saturday, August 8 8:00 AM–12:00 PM MT Recommended contribution: $80 N,N-DMT JOURNEY Saturday, August 22 8:00 AM–12:00 PM MT Recommended contribution: $80 PSILOCYBIN JOURNEY Saturday, August 29 9:00 AM–6:00 PM MT Recommended contribution: $160

ABOUT YOU

Personal and emergency contact information

Full legal name Date of birth Email address Phone number PsiloVibe membership status Emergency contact name Relationship Emergency contact phone

ACCESS & SUPPORT

Recommended contribution

Our first priority is to give.

No sincere participant will be turned away solely because they are unable to make the recommended contribution. Contributions from those who are able help us source quality sacramental materials, maintain the sanctuary, support facilitators, and extend access to other members.

I am able to make the full recommended contribution. I am able to make a partial contribution. I am requesting participation without a financial contribution. I would like to discuss another arrangement.

Amount you are currently able to contribute

COMPLETE DISCLOSURE

Medications, supplements, and recent substances

Complete medication and supplement list Recent alcohol, cannabis, stimulant, opioid, kratom, sedative, MDMA, psychedelic, or other substance use

SAFETY SCREENING

Medical and psychological considerations

Please answer fully. Include current status, treatment, relevant dates, clinician guidance, and anything else our review team should understand.

Medical history and current physical health Mental health history and current psychological stability Clinician restrictions, concerns, or available medical clearance

YOUR READINESS

Experience, intention, and present state

Previous psychedelic or ceremonial experience Prior difficult, destabilizing, or medically significant reactions What is your intention for this journey? How would you describe your current emotional and psychological state?

BEFORE & AFTER

Transportation and post-journey support

Transportation plan Post-journey support plan Anything else facilitators should know

FINAL ACKNOWLEDGMENTS

Review and submit

I confirm that the information I provided is complete and accurate. I agree to disclose all medications, supplements, substances, and relevant medical or psychological information. I agree to follow preparation instructions, facilitator directions, and community conduct expectations. I understand that I may not drive after participating and will maintain a confirmed transportation plan. I understand that submission does not guarantee acceptance and that PsiloVibe may request a screening conversation, medical clearance, postponement, or decline participation. I consent to being contacted by the PsiloVibe team regarding this application.

After submission, you will receive an on-screen confirmation and a confirmation email containing your private reference code.

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REGISTRATION RECEIVED

Thank You for Beginning With Honesty.

Your registration has been received and will be reviewed for medication, medical, logistical, and safety considerations. Submission does not guarantee participation.

Reference code:

A confirmation email has been sent to the address you provided. Please keep your reference code for future communication.