Divine Nature

Provisional Membership Application

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Age verification(Required)

I'm at least 21 years old, and I understand that I'll be asked for government-issue photo ID before participating in any ceremonies.

Do you have previous experience with psychedelic plant medicines?(Required)

Yes

No

Your experience level(Required)

Beginner: Tried once or twice / No breakthrough experiences

Novice: Several ceremonies / Some breakthrough experiences

Expert: 10+ ceremonies / Multiple breakthrough experiences

Do you have or have you ever been diagnosed with schizophrenia?(Required)

Yes

No

Are you currently on any antidepressant medications?(Required)

Yes

No

For your safety and ours, please list your antidepressant medications:(Required)

Do you have any heart- or brain-related health conditions?(Required)

Yes

No

For your safety and ours, please let us know about your heart- or brain-related health conditions:(Required)

Please tell us a little about yourself, and what you'd like to accomplish with plant medicines:(Required)

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