Summer Series Interest Form Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Describe your experience of yourself and your life at this juncture. Why are you called to this particular program? * Have you ever done any type of health cleanse, detoxification program, or fasting in the past? If yes, describe what it included, supplements, length of time, etc. * Do you have any current or historical medical conditions that may be a factor in your participation in a backpacking, wilderness retreat? * Thank you! Your form has been submitted. Please reach out to info@awrenessintitute.org if you have any questions.
