Let’s make this as easy as 1, 2, 3!

1—Fill out your form

2—Book Your Tickets

3—Join Us November 4th

Name

First Name

Last Name

Birth Date

YYYY

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (By submitting your number and clicking SEND you give consent to text communication from Amy Leiter. Message and/or data rates may apply.

Country

(###)

###

####

License/Passport Number

License/Passport Expiration

License/Passport Issued

Date of Issue

YYYY

License/Passport Place of Issue

Flying Arrival Date and Time

Arrival in Palm Springs/Joshua Tree

Flying Departure Date and Time

Departure in Palm Springs/Joshua Tree

How can we make your trip delightful and safe?

not required

Any dietary allergies, restrictions, or preferences?

Mental and Physical Health: Please list any physical disabilities, allergies, conditions, past injuries or any limitations we need to know about. If there are no conditions respond none.

Psychological Conditions: Have you ever been diagnosed with epilepsy, depression, schizophrenia, bi-polar disorder or any other psychological conditions?

Any allergies to or medications, reptiles, insects, animals?

I understand I am responsible for all transportation to and from the Airbnb

Joshua Tree Gathering Facilitators: Amy Leiter & Linds Shelto 📍 61030 Navajo Trail, Joshua Tree, CA 92252 📅 October 24 (12 PM) – October 27 (8 AM), 2025

I understand during this trip, I may be a passenger in vehicles owned or rented by other participants. I release all drivers, as well as Amy Leiter and Linds Shelto, from any liability related to transportation. I understand and agree

Joshua Tree Gathering Facilitators: Amy Leiter & Linds Shelto 📍 61030 Navajo Trail, Joshua Tree, CA 92252 📅 October 24 (12 PM) – October 27 (8 AM), 2025

If I should warrant immediate medical attention while on this retreat, I hereby grant permission to the medical personnel contacted to review my personal records or to contact the appropriate physician, psychiatrist, health professional or psychologist to obtain additional information on the conditions noted.

If I should warrant immediate medical attention while on this retreat, I hereby grant permission to the medical personnel in attendance or contacted to order x-rays, routine tests and treatment for me in the event the emergency contact cannot be reached.

If I should warrant immediate medical attention while on this retreat, I hereby grant permission to the physician selected by Beyond Therapy representatives to hospitalize, secure proper treatment for, and order injections and/or anesthesia for, and/or surgery for me.

I have read, understood, and agree to all terms, policies, and releases outlined in this form, including the refund policy, assumption of risk, community agreements, and substance policy. All statements I have made in this document are accurate and correct to the best of my knowledge at the time of submission. I agree to update the staff of Con Smania CR with any additional information pertinent to my attendance at the retreat.

Likeness and Media Release

I agree to Likeness and Media Release,

Acknowledge and accept all risks associated with my travel and participation in the Joshua Tree Gathering and release Everyday Illumination, Beyond Therapy, Amy Leiter, and Linds Shelto from all liability before, during, or after the event.