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WORLD DOCTOR
ABOUT
EVENTS
RESET PRACTITIONER TRAINING
RESET RETREATS
EMBODYING PSYCHEDELIA
ONE DAY RESET
SERVICES
RESET WITH A PRACTITIONER
CLINIC WITH DR MARIO ALAM
MEDIA CENTRE
INTERVIEWS
PODCAST SERIES
DOSE OF PSYCHEDELIC SCIENCE
CONTACT
EMBODYING PHSYCHEDELIA
Presenter, Artist and Performer Application
First name
Last name
Email
Code
Mobile Phone
Street Address
City
Region/State/Province
Postal / Zip code
Country
Date of Birth
Website Address
Facebook Profile
Instagram Profile
Current Job/Profession
It is a requirement for Presenters, Artists and Performers to have their own Public Liability insurance. If you answer NO and are invited to present you will need to obtain insurance prior to the event.
*
Yes
No (required if accepted)
Please upload your public liabilityinsurance in PDF format.
Upload Public Liability PDF
Upload supported file (Max 15MB)
You will need to sign a film and photography release form, which will be sent for digital signature.
*
Yes
Please upload your public liabilityinsurance in PDF format.
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