Elemental Ascension Application

First Name *

Last Name *

Phone *

Email *

Instagram Handle

How did you hear about Elemental Ascension?

The Woman You Are Today

What season of life are you currently navigating?(Examples: career transition, divorce, grief, relationship changes, spiritual awakening, reinvention, motherhood, empty nesting, etc.) *

What feels heavy in your life right now? *

What are you carrying that you're ready to put down? *

What is one area of your life where you feel called to grow? *

The Woman You Are Becoming

Imagine it is one year after Elemental Ascension.

Your life feels aligned.

You feel free.

You feel fully yourself.

Describe that woman.

What has changed? *

What are you most hoping to reclaim through this journey? *

What vision are you ready to rise into? *

What would make this experience transformational for you? *

Readiness

Are you willing to participate in group experiences and discussions? *

Yes

Are you comfortable with light physical activity, including hiking? *

Yes

Are you able to attend all retreat activities? *

Yes

Do you have any dietary restrictions, allergies, or health concerns we should know about?

Vegetarian/Vegan

Gluten-Free

Dairy-Free

Nut Allergies

Shellfish Allergies

Food Allergies or Medical Dietary Needs (Please list any food allergies, sensitivities, or medical dietary requirements we should be aware of.)

What is your favorite comfort food or meal that makes you feel nourished? *

Why is now the right time for you to say yes to yourself? *

Why do you feel called to Elemental Ascension specifically? *

If your future self could send you one message today, what would she say? *