Application form
Name as it appears on passport
Address
Country
Home phone
Mobile
Email
Occupation
Gender Male Female
Date of Birth
Emergency contact name
Phone
Do you have any medical conditions we should know of in case of emergencies?
  Yes No
Details
Diet Vegetarian
Vegan
Non-vegetarian (meat, fish, chicken)
Different
Food allergies and restrictions
 
Have you had any previous experience with shamanic plants?
 
Why do you want to come to this event?
 
What do you expect from this retreat?
 
How do you handle crises ? Explain:
 
Have you spent any time with shamans?
 
Are you currently taking any kind of medication? Explain:
 
Health insurance for travel, company nd policy number:
 
How did you learn about us?
 
Any other comments
 
Date of the seminar you want to attend:
 
In a scale from 1-3, how well do you speak English? 1 2 3