Retreat Application Form Vortex of Change Retreat Application First of all, thank you for taking the time to fill out an application for Lucia’s Vortex of Change retreat in Vilcabamba Ecuador. It helps us ensure that your background is a good match for this event, which will be energetically strong. Upon acceptance to the retreat, you will be contacted via email with details about how to proceed with your deposit payment and 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 Attended a 2017 Lucia, Light & Laughter workshop 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 4 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 retreat.4. Have a stable emotional processing techniqueI 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.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.