Apply to Join Rae of Light Ministries — Rae of Light Ministries

By applying to become a member of ROLM, you are acknowledging that ROLM is a spiritual organization, and that it is your desire to join ROLM with the purpose of pursuing your own spiritual growth.

Our detailed application is to ensure participants can healthfully, and safely join us.

To become a member of ROLM, complete our application below. Once we receive your fully completed application, we will contact you to schedule a brief phone interview.

We are aware that some of the questions in our membership application are personal in nature. In order for us to get to know you better, and to make sure there is nothing contraindicated for you to do this sacred work, we do need you to fill out the questionnaire completely and one of our team will be in touch with you to have a private conversation. We will never share your personal information.

PLEASE NOTE: All fields are required. If you miss a field, your application will not be submitted. Please double-check to make sure you have filled every field before submitting.

Application for Membership

Important Note: If you are taking – or have taken in the past three months – antidepressants or medication for high blood pressure, you are not eligible to participate in sacred ceremonies. To discuss options, contact us for further information.

All fields require an entry. Only one person per application, please.

Please also note: In communications via email, text, web, and phone, we do not refer to our sacrament by its traditional name. Instead, we use the name “Mamacita.” Please join us in this effort whenever you are communicating with us, including here in your application. Thank you.

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Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Create your username*

Be sure to make a note of your Username and Password, as you will need them to continue the application process.

Create your password*

Enter Password Confirm Password

Email*

Enter Email Confirm Email

We love your privacy. Your information is safe with us! We'll never sell or share it.

Phone*

REQUIRED: Please Submit a Recent HeadShot Photo of Yourself (no sunglasses or hats)*

Please submit a clear, recent, HEAD SHOT photo of yourself showing your face clearly (no sunglasses or hats). PLEASE NOTE: THIS SYSTEM WILL REJECT YOUR QUESTIONNAIRE UNLESS IT HAS YOUR PHOTO ATTACHED (jpg, gif, png, jpeg, pdf, heic, avif, or WebP).

What is your birthdate?*

What is your height?*

(feet and inches)

What is your weight?*

(lbs)

Emergency Contact*

First Last

Relationship*

Emergency Contact Phone*

Emergency Contact Email*

What is the full name of the person who referred you? We only accept new applicants by referral.*

What is your occupation?*

Please tell us about your intentions for working with our sacrament and what you hope to get out of the experience.*

Have you had any prior experiences with our sacrament or other entheogens/plant medicines?*

Yes

Please describe any prior experiences you have had with plant sacraments, entheogens, psychedelics, or psychotropic substances (what kind, how often, etc.).

Your State of Physical and Mental Health / Substances / Medical Info / Dietary Info

Please be aware that if you do not disclose any and all substances that you may be taking or have taken within four months of your requested Sacred Ceremony date (pharmaceuticals, medications, over-the-counter drugs, natural supplements, recreational substances, and any other substances), and/or any health conditions, psychological disorders, or addictions you are currently experiencing or have experienced at any time in your past, you may be putting yourself and the facilitators of this work at serious risk.
Some substances, such as most drugs in the antidepressant category, are severely contraindicated with this Plant Medicine, and the combination CAN BE FATAL.

For more information, see the "About Working With Plant Medicine: Step 3" section of this application process.

Please list ANY AND ALL pharmaceuticals, over-the-counter drugs, and/or other medications that you are taking or have taken within 4 months of your intended first ceremony date, or will be taking around the time of your intended first ceremony date (include name, dosage, frequency). If none, please type "none."*

Please list ANY AND ALL recreational substances that you are taking or have taken within 4 months of your intended first ceremony date, or will be taking around the time of your intended first ceremony date. If none, please type "none."*

Please list ANY AND ALL natural supplements (herbal, homeopathics, vitamins, minerals, etc.) you are taking. If none, please type "none."*

Do you have any history of depression or psychological diagnosis (such as borderline personality, bipolar, schizophrenia, psychotic breaks, etc.)?*

Yes

No

Please explain*

Do you have any history of addiction?*

Yes

No

Please explain*

Has your doctor ever told you that you have a genetic or medical condition that would prohibit the processing of tryptamine or tryptamine derivatives?*

Yes

No

What is that condition?*

Please tell us about any cardiovascular disorders you may have and/or any problems with your blood pressure, liver, or kidneys. If none, please type "none."*

Please tell us about any hospitalizations or other significant medical issues/histories you have had. If none, please type "none."*

What, if any, are your dietary restrictions? If none, please type "none."*

Do you have any allergies or other restrictions?*

Yes

No

Please explain*

Is there anything else about your physical or mental state we should know about? If no, please type "no."*

ENTRIES ARE REQUIRED IN EACH AND EVERY FIELD OF THE ABOVE QUESTIONNAIRE. If a field does not apply to you, then type in "no" or "none." If any field is left blank or radio button is left un-clicked, or if you do not submit an appropriate HEADSHOT PHOTO of yourself, your questionnaire will be rejected by this system. Thank you.

NEXT: All members of Rae of Light Ministries and participants in Sacred Ceremony are required to sign (via e-signature, below) and agree to abide by our Agreement and Release Form for Sacred Ceremony, which includes our Codes of Conduct and Ethics.

At the end these documents, please complete the e-signature in order to indicate you have read them and agree to abide by them. This will also submit your completed questionnaire. Thank you.

ROLM Agreement and Release for Sacred Ceremony*
Indemnification and Release

I, being of lawful age and sound mind, in consideration of being permitted to participate in Traditional Amazonian Plant Sacrament (Sacramental Medicine) Ceremony (aka Plant Sacrament Ceremony or Sacred Ceremony) and related activities and programs run and/or operated by ROLM (Rae of Light Ministries) and partake of Traditional Amazonian Plant Sacraments administered by ROLM, and/or any organized activities and programming on site or in the region and associated properties of said hosts of ROLM, do WAIVE, RELEASE and DISCHARGE ROLM, its owners, officers, directors, ministers, representatives, associates, members, facilitators, volunteers, retreat hosts, and legal representatives of the above noted activity and each of them their owners, officers and employees, from all liability for or by reason of any damage, loss, or injury to my person and property, even injury resulting in the death of the Releasor (myself), which has been or may be sustained in consequence of my (the Releasor) participation in the activities described above or sustained on the grounds and property of the Releasees or during organized programming in regions conducted by the Releasees, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Releasee. I further agree to defend and indemnify them from any claims, suits or demands. I understand that this agreement is binding upon me, my spouse, parents, family, heirs, executors, administrators, agents, and assigns. I also acknowledge that by signing this release, I will be forever prevented from suing or otherwise claiming against the Releasees for any property loss or personal injury that I may sustain while participating in or preparing for the above noted activity.

Agreement to Follow Directions

I have fully read and understand the information that has been provided to me about the Plant Sacrament (aka “Mamacita”), its uses, effects, and the appropriate preparations for participating in Plant Sacrament Ceremony (aka Sacred Ceremony). I agree to follow all instructions, directions, and requirements as given before, during, and after Sacred Ceremony, by the ROLM team of ministers, facilitators, guardians, guides, and assistants. I have fully read and understand the pre-ceremony dietary requirements that, when followed, will allow the plant sacrament to work with me more deeply and effectively. I am willing to abide by the dietary guidelines for at least three to five days prior to Sacred Ceremony, although I am aware that longer dietary cleansing is beneficial.

I understand that the facilitators reserve the right to deny my participation at any time (before, during, or after Sacred Ceremony) if they deem that it would be unsafe for me, or for others, or for any other important reason.

I agree to remain to the closing of any Sacred Ceremony which I choose to begin (Sacred Ceremony closes after the subsequent sharing circle is complete).

Transparency and Full Disclosure

I hereby confirm that I have answered all the questions in the Application for Membership (and the included Questionnaire) completely and honestly, and have not withheld any information.

No Duress

I agree and acknowledge that I am under no pressure or duress to sign this Agreement and Release Form, and that I have been given reasonable opportunity to read and review it before signing. I understand that my participation in Sacred Ceremony is purely voluntary.

I understand that during the Sacred Ceremony in which I participate, I will ingest an entheogen Plant Sacrament. This Plant Sacrament is a natural, combined extract of the plants Banisteriopsis Caapi and Psychotria Viridis that grow throughout the Amazon Basin in South America. I have been informed of its effects, as well as the objectives of taking it within the ritual/ceremony led by experienced Sacred Ceremony leaders. I am attracted to this Plant Sacrament with the intention of a potential, profound spiritual experience and pursuit of spiritual growth. I understand that the facilitators make no claim or promise regarding the curing of any illness or the nature of any spiritual experience. I understand that the Sacred Ceremony is personal and sacred to each individual, and that what may occur for one person may not necessarily lead to the same experience in others.

Costs and Fees

I agree to pay for any and all damages to the facility in which my Sacred Ceremony (or ceremonies) takes place caused by any negligent, reckless, or willful actions by me or my family. I also agree to pay any and all fees related to my participation in Sacred Ceremony (or ceremonies) as and when specified by ROLM.

Assumption of Risks

I hereby acknowledge and voluntarily assume the full risks and responsibilities of my participation in Sacred Ceremony, including the possibility of any physical or other injury, damage or losses, either to myself or caused to others by me during any Sacred Ceremony organized by or held on the property of the facilitators and/or ministers. I understand that the Sacred Ceremony in which I choose to participate may be physically, mentally, emotionally, and/or spiritually demanding. I understand that I may experience dizziness, nausea, or other physical upsets including vomiting and diarrhea. I accept full responsibility for anything that may occur including emotional disturbance, mental disorientation, and any and all possible manifestations of physical, emotional, and/or mental changes. I acknowledge that the risks and potential benefits of my participation have been explained to me and I freely choose to enter this process accepting full responsibility for whatever may occur, anticipated or unanticipated.

Physical and Mental Health

My general health, as far as I am aware, is good. I acknowledge that I do not have any physical limitations, medical ailments, physical or mental disabilities or disorders that would limit or prevent me from participating in Sacred Ceremony, and, if required, I will obtain a medical examination and clearance. If I have any such physical or mental limitations, ailments, disabilities, or disorders that I am aware of now or in the future, I will inform the Releasee (ROLM) in writing before participating in such activities.

Drugs, Substances, and Supplements

I confirm that I have informed ROLM of any and all drugs/medications/pharmaceuticals (including prescriptions, over-the-counter drugs, recreational drugs) and/or natural supplements that I may currently be taking, plan to take in the future, or have taken within no less than four months of the Sacred Ceremony in which I plan to participate. And, if I have taken any of these substances, and ROLM informs me that the substances I have been taking are contraindicated with the Plant Sacrament, I will stop taking these substances exactly when and as advised by ROLM, and/or I understand that I may need to postpone my participation in Sacred Ceremony to a later date, so these substances are not in my body at the time of the Sacred Ceremony in which I will be participating.

Code of Conduct

I commit to living a sacred, Earth-honoring lifestyle which embodies the ROLM Principles of Gratitude, Humility, Faith, Respect, Honor, and Charity.

I commit to making an effort to spend time each day in meditation and/or prayer, drawing closer to Great Spirit/Source/God and all of creation.

I commit to only use the sacrament and Sacred Ceremonies to empower my body, mind, and spirit, and to serve myself and others, with the intention to create peace and harmony in my relationships, in my body, and in my daily life.

I commit that I will keep the Sacred Ceremonies and what is shared there by others sacred and confidential, not sharing anything outside the circle.

I will never share sacraments with those who are not members of ROLM. I will never sell sacraments to any person, regardless of ROLM membership. I understand that doing so revokes my membership.

I will never manipulate or take advantage of others emotionally, sexually, mentally, spiritually, or physically that are in the open state during and after ceremonies or while using sacraments.

I agree and understand that peoples of all ethnic and religious backgrounds can be honored with ROLM membership.

I agree and understand that others may judge or criticize the organization (ROLM) by my attitudes, actions, and words. Therefore, I will not do or say anything that reflects poorly on ROLM and/or ROLM members and leaders. If I should have a problem with another ROLM member or with the ROLM community, I hereby agree to either address it directly with the other person, or through one of the ROLM organization leaders.

Code of Ethics

The world-wide work with this Plant Sacrament is dedicated to the revival and preservation of Ancestral Indigenous Native Earth-Based practices; honoring cultures, religions, spiritual practices, lifestyles, sacred rituals, healing sacraments and loving humanitarian Codes of Conduct and Ethics that protect Mother Earth and all of her living beings from desecrations, pollutions or abuses for economic gains.

The competencies of ROLM Ministers and Ceremonial Leaders are developed over years of observation, experience, and practice.

ROLM respects all empowerment and healing modalities; including: Indigenous Spiritual Ceremonies, allopathic medicines, naturopathic and integrative complementary medicines. ROLM honors the fundamental Hippocratic principle of “Do No Harm to the Spiritual, Mental, Emotional, and/or Physical Being” of anyone. It recognizes that each healing and empowering modality is intended to promote the optimal health and well-being of the participant. It believes that all forms of care can be incorporated into empowerment and/or healing for all of our relations, in a complementary and integrated manner.

ROLM is committed to growth by attraction through service rather than promotion for membership.

For ROLM Members and Leaders

PREPARATION AND SAFETY. Each participant must agree to comply with all directions or instructions concerning the safety and well-being of all in attendance by a ROLM Minister.

LIFE CHANGES. Often, the increased awareness gained from Sacred Ceremonies can catalyze a desire in the participant’s life for personal and social change. In most cases, these changes should only be made after deep introspection and consideration as to how they will affect the other beings connected to the participant.

CONSENT OF PARTICIPANT. The autonomy and dignity of each Member and Participant are to be respected by ROLM Ministers and Ceremonial Leaders. Participation in any ROLM Ceremony must be voluntary and based on prior disclosure and consent given by each participant while in an ordinary, rational state of consciousness.

RESPECT. ROLM Leaders and Members agree to conduct themselves in ways that cultivate awareness, empathy, and wisdom for all Members during ceremonies. ROLM Members also agree to respect, empower, and continually support the ROLM Ministers and Ceremonial Leaders as they serve the ROLM Community.

LIMITATIONS. Limits on the behaviors between ROLM Members and ROLM Ministers and Ceremonial Leaders are to be made clear and agreed upon in advance of any Sacred Ceremony.

MINORS. Those under 18 years old will not be admitted to ceremonies.

CONFIDENTIALITY AND CUSTOMS. Cultural/religious customs and confidentiality of all participants are to be accepted and honored by all ROLM members.

ABUSE WILL NOT BE TOLERATED. ROLM has zero tolerance for any manner of physical, verbal, and/or sexual abuse. Violation of this Ethic by any ROLM member will subject the violator to the full consequences of the Law.

SACRAMENTS UNDER DIRECTION OF MINISTERS. Members of ROLM agree that any substance admitted into the body may be considered to be a sacrament. Some of those substances have the potential to be harmful if inappropriately used. ROLM does not approve of the utilization of any sacrament in a manner that would be likely to cause harm to one’s self or to others. Therefore, members agree that “controlled” substances must be used under the direction of ROLM Ministers (Sacramental Ceremonial Leaders and Facilitators) to be legally protected. Personal or recreational use of any controlled substances is not encouraged and may be grounds for dismissal from membership.

INCLUSIVENESS. ROLM ceremonies are to be conducted in the spirit of service. ROLM Members agree to participate in ceremonies and other events respecting all participants and leaders regardless of race, color, religious affiliations, gender, gender identity, sexual orientation, cultural background, financial status, age, and/or political affiliations.

I hereby agree and understand that my being a member of Rae of Light Ministries (ROLM) puts me in a very sacred and privileged position. I am committed to faithfully living and practicing my spiritual pathway in alignment with these sacred ROLM Codes of Conduct and Ethics.

This release contains the entire agreement between the parties to this release, and the terms of this release are contractual and binding.

By completing this e-signature and checking "I agree," you are consenting to the use of your electronic signature in lieu of an original signature on paper. You will be sent, by email, a copy of the Agreement and Release for Sacred Ceremony that you have signed. By completing this e-signature and checking "I agree," you are agreeing to abide by all the terms outlined in this Agreement and Release Form for Sacred Ceremony and by the Codes of Conduct and Ethics. You are also confirming that it is your desire to become a member of Rae of Light Ministries with the purpose of pursuing your own spiritual growth.

I agree

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