Registration Form

Awakening 2025: A Two-Day Journey of Releasing and Renewing

* Indicates required field

Name *

First

Last

Email *

Preferred Name *

Phone Number *

Why do you feel called to attend Awakening 2025: A Two-Day Journey of Releasing and Renewing? *

Which payment form will you use? (Please note that some fees may be added to cost-(For example Pay Pal Fees) *

Zelle (Preferred) [email protected] Venmo @Shanika-Purnell Cash (Preferred) (Established Clients Only) Credit/Debit card CashApp $sunshyneislove Paypal (Please add PP Fees) I would like to do a payment plan. Past Student Special (Call for Details)

Please note: When using Cashapp, PayPal, Venmo. There are fees associated with them. To ensure that the full payment is made, please utilize the fee calculator when directed to the payment options. If you need help, call us at 678-824-5025, we will be happy to assist. (Please Note the fees may range $2-$4 dollars give or take. *

I will be sure to add the fees to my total. I need assistance with adding fees. I will not pay the fees added, so I will not be attending this event

City & State *

Which day(s) are you attending? *

FULL EXPERIENCE: ($155) Both days Day 1 ONLY: ($111) Releasing Day 2 ONLY: ($88) Renewing

Do you have any questions? *

HOW DID YOU HEAR ABOUT US? Let us know if someone referred you. *

Cacao Ceremony (Intentional Vision)

The dress attire is, wear the colors, White, Pink or Green. Is this understood? *

Yes I will I have questions. I will not be attending Day 2

Have you ever ingested ceremonial cacao before? *

Yes No I don't know I will not be attending Day 2

Please bring a bouquet of white, pink flowers or green plant OR bring a candle (Pillar, Votive or 7-day). Be sure the candles are white pink or green. Is this understood? *

Yes, I understand I have questions I will not be attending Day 2

Please Hydrate 24-48 hours before the ceremony. *

Yes, I will hydrate I have questions I will not be attending Day 2

Please list any food allergies, Food dislikes, Specialty diets(Vegan, Gluten Free etc.) or food restrictions. N/A if none. *

Please refrain from using any mind altering substances preferably 24- 48 hours leading up to the ceremony. This includes, alcohol, marijuana, THC products, psychedelic etc.) *

Yes, I understand I have questions I will not be attending Day 2

Before consuming cacao, please check all that apply to you. *

I currently take MAIO antidepressants or SSRI’s antidepressants I am currently Pregnant and/or Breastfeeding. I have been diagnosed with IBS (Crohn's, Colitis, Diverticulitis etc.) I have a bleeding disorder I am allergic to chocolate I am under the age 16 I have High Blood Pressure I have Low Pressure I am sensitive to caffeine or stimulants I have been diagnosed with epilepsy or a seizure disorder I have a history of psychosis If you take antipsychotic medication If you are taking 5-htp If you are taking St John's Wort If you are allergic or sensitive to theobromine None of these above I will not be attending Day 2

There will possibly be video and photography during these events. Do we have permission to take photos/videography used for marketing on social media, website and any other visual component? *

I give my consent to take photos of me. I opt out

I agree to receiving marketing and promotional materials *

Submit Registration

Other Payment Options

Awakening 2025: A Two-Day Journey of Releasing and Renewing