Booking Form “Ayahuma” venue (PERU) – Ayahuasca, Camalonga and Shamanic Plant Diet Apprenticeship retreats

Please fill-in all relevant fields and forward this online booking form, to formally comply with our reservation procedure.

Programme

Programme *

Preferred Date to Start Your Retreat (Please use the format Day/Month/Year: DD/MM/YY):

Alternative Preferred Date to Start Your Retreat (dd/mm/yy):

Length of staying (total number of weeks/days):

Travel Details

Include flight number, Airline name, date and time of arrival/departure for your domestic flight details in Peru.

National flight details: arrival in Iquitos (if known/applicable)

National flight details: departure from Iquitos (if known/applicable)

Number of travellers:

Personal Details

Title:*

First Name: *

Middle Name:

Family Name / Last Name: *

Age: *

Address: *

City: *

ZIP/Postal Code: *

State: *

Country: *

Daytime phone: *

Evening Phone:

Mobile Phone:

Fax:

Email *

Verify Email *

Alternative Email

Vegetarian: *

Date of Birth (dd/mm/yy): *

Place of Birth: *

Nationality: *

Passport Number: *

Country of Issue: *

Issue Date: *

Date of Expiry: *

Contact in case of emergency: *

Other

Interpreter Spanish-English required: *
YesNo

Where did you hear about us? Check all the boxes applicable:

Word of mouth/referral by a friendAdvert on a magazineAdvert on the internetGoogle or other search engineArticle on a magazine/newspaperSupernatural (Graham Hancock's book)Other (Please specify)

Payment: *
I have already paid

I have still to send the payment

Comments:

Mail list: *
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IMPORTANT: THIS IS A BOOKING FORM, NOT A CONTACT FORM. DO NOT SEND THIS FORM UNLESS YOU HAVE ALREADY SENT THE PAYMENT (initial deposit, final balance, or full payment), or you will be legally liable to pay the full invoice value of your retreat, regardless of your circumstances.

I have read, understood and accepted the terms and conditions of participation to the retreat in the "Ayahuma" venue, as published at the URL:

http://www.elmundomagico.org/terms-and-conditions-ayahuma-venue-peru/

I voluntarily agree to fully abide to these conditions as written. I understand that this is a legally enforceable document, that the validation time of this agreement between me and El Mundo Magico Ltd is three years and starts on the first day of signing the present Agreement of participation, forwarding my booking form, or sending my payment, whichever is earlier.

Signature (re-enter your full name): *

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