APPLICATION FORM FOR PERU RETREAT

Hello we ask these questions to make sure that you have the best experience possible and your well being is looked after.

This application will take you 7-15 min to fill out so you may put on some music and jump in.  People find that the questions themselves support their journeys.
This form will only be seen by Jeffrey Slayter and a few of his key team members who support the adventure.
APPLY NOW
 
Personal Information Section

 
What is your first name? *

 
What is your last name? *

 
What is your mobile with country code? *

 
How did you hear about this?

 
Are you a member of the Entrepreneurial Elders Group?

If not it's okay.
 
Have you been on adventure with Jeffrey Slayter to the South America before?

 
Business, Vision and Values

 
Please share the name of the current annual turnover in US dollars? *

 
What is your position in your company? *

 
What industry are you in? *

 
Whats is the name of your company or companies? *

 
What do you hope to gain out to spending time diving into yourself with other high performing entrepreneurs? *

A paragraph is fine.
 
Their are lots of places to go into the jungle, why do you want to go with us? *

 
On a scale of 0 - 10, how willing are you todo the deep work necessary to grow yourself and business?

(0 being not inspired to change and 10 totally inspired)
 
How will you plan on giving back to this world as you come across more abundance in your life and business? *

 
How would you like this to impact your life and business? *

 
Your Wellbeing

 
Have you ever been diagnosed with any mental illness? if yes when? *

 
Are you in on anti-depressants or specific medications, and or pharmacy drugs? *

I know this can be a personal question for now just answer yes or no and more clarity will be needed later.

(Being on certain medications during ceremony can mean death or near death so we do not take this lightly)
 
What is your experience with transformational work in the past? *

 
Have you ever journeyed with plant medicines before?  What ones and how often? *

 
If you form is filled out we will be in touch with you regarding your application within 3 business days.

Thanks for completing this typeform
Now create your own — it's free, easy & beautiful
Create a <strong>typeform</strong>
Powered by Typeform