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New Member Application

Welcome to our community! We appreciate your interest in joining us. Please take a moment to complete the new Member Application form, and upon completion, kindly proceed to the Member Questionnaire to help us understand your needs better.

New Member Application

Once you complete this form, continue to Member Questionnaire.

First Name

Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

How Can We Reach You?

Call

Text

Email

Phone

Email Address

Confirm Email Address

How did you hear about us? (Required) *

HCU Clinic

Family/Friend

Internet/Website

Social Media

Email

What Member Services Interest you? (Required) * Required

General Wellness - Self-guided microdosing and supplementation

Specific Issue - Work on a health problem either self-guided or with some support

Supported Use - Work with a therapist, counselor, clinician, or guide while using microdoses

Preparation for Hero Dose - Interested in high-dose trip with a psychedelic guide in the future

Spiritual / Ceremonial - Use as a sacrament alone or in a group

Are you interested in Group Events? (Required)

Online Group Events (Group chats, spiritual circle, special groups - veterans, women, dog lovers, etc)

In-Person Groups Events (hiking, spiritual circle, mystic yoga, etc)

Both Online and In-Person Events

Not interested

Date of Birth * required

Upload Photo of Front of Colorado ID or Drivers License

Upload File

Max. file size: 64 MB. You must be a Colorado Resident age 21 + to join

$42 Membership Fee paid by: (Required) *

Cash

Credit / Debit

Other

Your Comments or Questions

I agree to the terms & conditions

HCU Mushrooms

720-443-2420

contact@hcumushrooms.com

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