medicine of the rose
womens retreat Application

Thank you for your interest in joining us for our upcoming Medicine of the Rose Women’s Retreat taking place on June 5-9, 2025. I am SO happy you are here saying YES to giving yourself this gift!

Please fill out your responses below as soon as possible and I will be in touch with you within a few days. Only apply if you can commit to these dates and the full cost of the retreat.

All information given is held in confidentiality and will not be shared with any outside sources.

With love,
Sakura xo

Name

First Name

Last Name

Phone Number

(###)

###

####

Location (City, Country)

What draws you to this retreat and to work with Rose Medicine?

Are you currently experiencing trauma, addiction and/or mental health challenges? If yes, please provide a brief description of the challenges you face.

How did you hear about this retreat? (If you have taken any progams with lead retreat guide Sakura Rose and/or retreat guest teachers Theda Phoenix, Astika Rose or Irene Sanchez-Celis, please mention and list.)

I am devoted to my self-discovery, mastery and ready to enter into sacred sisterhood

YES

I am committed and able to pay the full retreat tuition either in full or via payment plans and understand that there are no refunds (retreat cost is outlined on retreat webpage)

YES

I prefer to pay in:

Canadian Dollar CAD

US Dollar USD

What do you most desire to receive and take away from this retreat?

Have you experienced a women's retreat, event or sisterhood before? If yes, how has this influenced your ability to be in a group dynamic?

Do you have any hesitations around joining? If yes please share.

What feels most true to you:

I am 100% in

I am interested, but not 100% sure yet

I have some questions and require some more info before fully committing

Is there anything else you wish to share with us that feels relevant?

medicine of the rosewomens retreat Application

divinity rising

medicine of the rose
womens retreat Application