Application Form

General Application for Student Membership and participation in PSS1 & PSS2 program levels of the Mindfulness-Based Psychedelic Therapy Training Program of the Center for Medicinal Mindfulness.

Name:

Personal Information


Program Interest


Personal Support & Emergency Contact Information

You certify that your personal support and emergency contact knows about your interest in our program and agrees to be your friend/ally during the training, is generally available, and agrees to be contacted in case of an emergency.