Alumni Only Retreat

1 Welcome

3 People in your group

4 Optional Items

Additional Massage

60 minute hot stone massage

$75.00

Select quantity

Extraction Class

Learn the technique to extract from legal, easy to source plant materials in this optional add-on class.

$275.00

Select quantity

IV Therapy- Vital Energy

Ingredients: 500 ml saline solution 5 g Vitamin C 600 mg Glutathione 50 mg Zinc 250 mg Magnesium

$220.00

IV Therapy- Mindful Clarity

Ingredients: 500 ml saline solution 300 mg Chromium 2 mg Vitamin B12 300 mg Magnesium

$185.00

IV Therapy- Inner Glow

Ingredients: 500 ml saline solution 10 g Vitamin C 1 g Glutathione 500 mg Collagen 40 mg Zinc

$220.00

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5 Participant Info

Phone *
Age: *
Tell us about your goals. What brings you to Eleusinia?	Consciousness Exploration Mental Health Improvement Chronic Pain We want to be best prepared customize your experience to help you achieve your personal goals.
Tell us about your chronic pain condition.	The more we know about your condition, the better we can prepare to make your retreat experience comfortable and coach you toward better results. Please mention if you struggle with migraine, arthritis, fibromyalgia, or other types of neuropathic pain.
Tell us about your interest in consciousness exploration.	Do you have an established meditation practice? Are you looking to establish one?
What kind of struggles have you experienced with mental health?	Please list your current challenges. Do you struggle with anxiety? Depression? Addiction? Relationships and connection?
Are you currently taking any medications? *	Sharing your current medications will help us further customize your experience.
Please list your medications. *	No need to worry if you don’t have all the details right now – you’ll be able to update this information after registration. Most commonly prescribed antidepressants do not interfere with the substances used at Eleusinia, so please feel free to share this information. We ask for it to ensure you have the best possible experience. Upon arrival at the retreat, you will also have a one-on-one consultation with our medical team to review your medications.
Have you experienced psychedelics in the past 5 years? (Please exclude microdosing)
Tell us about your psychedelic history.
Have you ever suffered from schizophrenia, other forms of psychosis, mania, or a personality disorder? *
Please provide details regarding your experience. *	If your participation at Eleusinia is deemed inappropriate, your deposits will be refunded in full.
Have you ever been prescribed lithium? *
I agree not to consume lithium within 30 days of my retreat date. *	Initials
Have you struggled to have a psychedelic experience in the past?	If you have struggled to have a psychedelic experience in the past, we want to take extra steps to make sure this experience is successful for you.
Tell us about struggles with past psychedelic experiences.	What was the substance? What was the dosage? Was it in a recreational or therapeutic setting?
Diet Considerations *	Please keep in mind that your meals will be carefully prepared based on your answer here and may result in your dishes being different from what is presented on our regular menu.
Diet Notes
The vegetarian meals at Eleusinia generally fit most kosher requirements. If you require additional steps, please let us know.
Terms and Conditions *	I accept the terms and conditions.Please read the terms and conditions
Payments do not include the cost of plant medicines. *	I understand that payments made through Retreat Guru do not include the cost of: psychedelic products. All psychedelic products and services are offered on a complimentary basis in conjunction with your stay at Eleusinia.. There will be no additional charges for this retreat.Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

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Guest 1		First Name* Last Name* Email*
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1 Welcome

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