Name/Nombre *

First Name

Last Name

Phone number/Número de Teléfono *

Country

(###)

###

####

Do you live in the United States or internationally? *

*The monthly Plant Medicine Potion is shipped to all members within the United States. International members can source their own herbs using the recipe included in the monthly email.

United States (HI, AK)

International

Are you energetically available to sponsor another Womban’s WombSteam Journey with the WOMBNation? *

*responding yes to this question adds you to a list of potential Sponsors for applicants who are in need of the work but unable to make their own financial exchange at this time

Yes

No

Do you wish to join WombNation as a sponsored member? *

Sponsored memberships are for BIPOC and/or marginalized women who are seeking healing or spiritual care through monthly WombSteams and are unable to make their own financial exchange at this time.

Yes

No

If you select the monthly membership we require that you subscribe for a minimum of three moon cycles, however you will still be billed monthly. Do you feel called to commit to a Trimester rhythm (3 moon cycles) or to a Full Term rhythm (12 moon cycles)? * *

Trimester

Full Term

Trimester (Recipe Only)

Full Term (Recipe Only