Retreat Application Form Vortex of Change Retreat Application A Special Note from Lucia... "As of 2018, I have changed the concept for my Vilcabamba Retreat. These retreats are powerful. And they send out a powerful wave into the ascended collective which directly affects the planet. The more cohesive the group is--the more willing the participants are to change and explore new terrain--the higher we can go and the greater the impact we can make. For this reason, I want to work with each woman at one of my in-person events beforehand. This way I know each woman personally; I know her energy and her willingness to change; and I know whether or not she will ultimately resonate with the November group I am forming. If that ends up being only a handful of women, that poses no problem for me. Better that the group is small and all participants share the same intent. So, may I suggest that, before taking the time to fill out the application below, you ponder the retreat concept and access your level of commitment to helping shift the energies on the planet. I hope this agrees with you... Upon acceptance to the retreat, you will be contacted via email with details about how to proceed with your deposit payment and with lots of helpful hints for planning your trip." Personal InformationName*Address* State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Your Email Address Confirm your Email Age*Occupation*Background with MetaphysicsDo you have a meditative practice?*YesNoIn 50 words or less, describe your current meditative practice (include time spent, frequency, and method(s)):*Do you have an emotional processing technique?*YesNoIn 100 words or less, describe your emotional processing technique (include method(s) studied):*In 50 words or less, describe any extra-sensory faculty that you possess (eg. clairvoyance, clairaudience):*In 150 words or less, describe your background in self-discovery:*In 50 words or less, tell us why you wish to participate in the Vortex of Change retreat:*The Vortex of Change Retreat is a working retreat. When we meet, all attendees will be working on a specific blockage, some limitation that is holding you back in terms of your evolution. If you had to decide today which issue to work on (it can change between now and the Retreat), what would it be? Please state the issue in 50 words or less:*Background - Medical & PsychologicalLucia asks for the following information because it allows her to gain insight into your background, conditioning, and current state of well-being. Your answers will be held in strictest confidence. The Vortex of Change retreat is strong. Because we will be working with you to help you go beyond the limited, personal self, it is important for us to know beforehand if there are potentially issues that may cause destabilization during the retreat.Do you have a chronic illness?*YesNoIn 50 words or less, please describe:*Are you currently taking any medication?*YesNoIn 50 words or less, please describe:*Have you, or any of your immediate family members, ever had any of the following experiences or addictions (check all that apply): Alcohol abuse Drug abuse Sexual abuse Overeating Nicotine abuse Eating Disorders Chronic or severe depression Attempted suicide Hospitalized for psychological reasons Diagnosed with any kind of psychological disorder If you have answered ‘yes’ to any of the above, in 150 words or less, describe each experience, including when these issues occurred:*In 150 words or less, describe how these experiences are currently affecting your life and what steps you have taken to deal with them:*Background with LuciaWhat is your familiarity with Lucia’s work? Please check all that apply: Read Lucia’s book, Unplugging the Patriarchy Attended large, public teleconferences Attended small-group calls to work on personal roadblocks Attended her 2010 workshop, Women Standing in Their Power or watched the DVD Participated in her 2011 offering, Beyond Mysticism Participated in her 2013/2014 offering Awaken Academy Attended Lucia’s 2014 workshop in Edinburgh Attended Lucia’s 2015 workshop in The Chilterns, outside of London Attended a 2016 Treasure Trove of Transformation workshop in Berlin or San Francisco Attended a 2017 Lucia, Light & Laughter workshop in Reston VA or Berlin Attended a 2018 Navigating New Earth workshop in Annapolis, Portland, Berlin, or London Attended a Vilcabamba retreat in the past Completed her Mystical Counsel emotional processing work-study course Completed her Women Standing vibratory processing work-study course Completed her No Woman Left Behind work-study course Completed her Master Class in Mysticism work-study course Received the Ancient Templates of Wisdom 1-90 Received Ancient Templates 91-94 Have a 12D Processor Have done the exercises in Lucia’s YouTube, Exit and Unplug the Matrix Have done the exercises in Lucia’s YouTube, Operation Clean Sweep AgreementsAgreements* I understand that there are 5 pre-requisites that must be completed prior to the retreat:1. Read Lucia’s book, Unplugging the Patriarchy2. Watch Lucia’s YouTube Exit and Unplug the Matrix and complete both exercises therein3. Read The Marriage of Spirit by Leslie Temple-Thurston because doing so will give the group a common, working vocabulary and will ensure you understand the way in which polarities are held within your conscious/unconscious mind, something we will be working with at the retreat4. Have a stable emotional processing technique5. Have worked with Lucia in-person at a previous live eventI also understand that it will not be possible to attend the retreat if these pre-requisites have not been completed prior to my arrival in Vilcabamba. I understand that my $195 retreat deposit is to reserve my space and that it is refundable up until 45 days prior to the event, as stated in Lucia’s Store Policy. I understand that, during the check-in procedure prior to the retreat, I will be paying the balance due for the retreat in USD cash and that only cash can be accepted in Ecuador. I understand that all room and board costs charged by the Madre Tierra resort will be handled separately and paid directly to Madre Tierra. I understand that, during the check-in procedure prior to the retreat, I will sign a Release Form stating that I agree to accept 100% responsibility for my experiences. PhotoUpload image*Please attach a recent (within 3 months), close-up photo, where your eyes are clearly visible. Your photo must be in the form of a jpeg or png file and no larger than 3 MB.Accepted file types: jpg, jpeg, png, gif.CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.