This document is intended as a formal Declaration of my Religious and/or Spiritual Beliefs.
I, the undersigned, do hearby declare that traditional entheogenic botanicals are an essential and inseparable part of my religious/spiritual practice.
Due to ecological and social factors adversely affecting sacred botanicals in their native habitats, I also acknowledge that cultivation of such is a bonafide religious/spiritual practice and responsibility.
I do therefore declare that my consumption and cultivation of holy sacramental botanicals including but not limited to Lophophora ~ "Peyote", Caapi/Psychotria/Diplopterys ~ "Ayahuasca", Trichocereus ~ "San Pedro" and Psilocybe Mushrooms to be a strictly religious/spiritual practice afforded First Amendment protection under the Constitution of the United States of America and is the birthright of each and every human being upon this Earth.
Print Name X __________________________
Date X __________________________
Signature X __________________________