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Before You Begin Poison Pushout is designed as a supportive, intentional experience. These questions help ensure the course is the right fit for you and for the group we’re creating together. There are no right or wrong answers. Just honest ones. Please take your time.

First & Last Name

Email Address

What drew you to Poison Pushout at this moment? (A few sentences is perfect.)

Lately, where have you been feeling the most "weighed down" – physically, emotionally, mentally, or energetically? (You don't need to share details you're not comfortable with.)

When you imagine feeling clearer and more at ease, what feels most important to you right now? (For example: energy, peace of mind, confidence, direction, boundaries, etc.)

Poison Pushout is a reflective, educational course – not a quick fix. What about this approach feels aligned for you? (Or what are you curious about exploring through it?)

Are you able to attend both in-person course days and complete the pre-and post-reflection work?

March 19-20, 2026 – El Puente- 211 South 4th Street, Brooklyn, NY 11221
Are you able to attend both in-person course days and complete the pre-and post-reflection work?
A
B
C

Is there anything you'd like me to know as I review your application? (Optional)

Did a Poison Pushout Ambassador refer you? If so, who?

Contact: cohort@poisonpushout.com