Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Mobile *

Country

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous Ayahuasca Experience *

Have you experienced Ayahuasca before?

Yes

No

Additional Services

Feel the call to join our Kambo ceremony? No need to commit in advance – simply let us know upon your arrival

Kambo Ceremony 2h (non-binding)

Liability Waiver *

Participants will be required to sign a liability waiver acknowledging the risks and responsibilities associated with the Ayahuasca retreat.

I understand

Code of Conduct *

Participants will be expected to adhere to a code of conduct during the retreat. Are you willing to comply with the guidelines provided?

Yes, I do

Terms and Conditions *

I have read and agree to the terms and conditions of the booking.

I agree