Membership form

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Medical Condition/s *

Briefly explain your expectations and goals with microdosing.* *

Have you used psilocybin or other psychedelics? If so, briefly describe your experience. *

Is there anything else you would like to ask or to add?

Upload your Photo ID *

Click or drag a file to this area to upload.