Full Name
Email
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Phone Number (with country code)
Date of Birth
Emergency Contact Name
Emergency Contact Phone Number (with country code)
Emergency Contact Email
Which workshop dates are you applying for?
Do you have any specific food allergies? The workshop diet is mostly vegan and where possible, organic.
Do you have any experience with psilocybin or other plant medicines? If yes, how many times and please share a summary.
Have you previously attended any retreat with Milli, psilocybin or otherwise? If yes, please specify.
If no, how did you hear about us?
Consuming psilocybin can have risks for those predisposed to serious mental health conditions. Have you ever had a psychotic episode or do you have a history of mental illness? If so, please describe.
Some medications and substances are potentially dangerous when combined with psilocybin, so for your own safety it is necessary that you notify us of any substances you are taking. In particular, do you use / have you recently used or are you likely to use the following: antidepressants, sleeping pills containing anti-depressants, antipsychotics, psychostimulants, lithium, other dopaminergic or serotonergic agents or any other medications? If yes: which, how much and how often?
Use of psilocybin can raise the heart rate and blood pressure. Do you have any serious or uncontrolled cardiovascular issues? If yes, please specify.
What is your intention for going on this journey? Why do you want to participate?
How are you doing in general? Do you feel you have enough stable ground to catch yourself afterwards?
Is there any other relevant information we should know about?
Terms & Services: Your registration is not confirmed until we receive this application form and your deposit. In the case that there are issues with the form, we reserve the right to cancel the registration and we will issue a full refund of the deposit back to the applicant within 14 days of purchase. Otherwise, you will receive an email with confirmation of your spot within 14 days. Do you agree?
Cancellation Policy: If a participant wishes to cancel the booking for whatever reason, the following terms shall apply: If you cancel over 4 weeks prior to the retreat start date, the deposit is non-refundable. 50% of the deposit fee will be retained as a cancellation fee. The remaining 50% of the deposit may be applied as a credit toward a Truffle Retreat within one year of the retreat start date. If you cancel within 4 weeks of the retreat, you will be legally committed to paying the full amount of the retreat fee, and no refund will be provided. Do you understand this and agree?
Do you confirm the answers you've given are correct and truthful?
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