Apply for a Retreat

To join us for an Ayahuasca retreat, please fill out this 4-step application and we will respond to you at the earliest possible.

The information shared in this application will be kept private and confidential.

For your own safety please provide accurate and truthful information.

Fields marked with * must be filled out, if your submission fails please look for the error message in the form.

Step 1: Personal Information

Full Name *

Address with State and Country *

Phone Number *

Email *

Gender * MaleFemale

Date of birth *

Facebook or other social media profile link *

Occupation *

Emergency contact name and phone number *

Step 2: Retreat Information

Why do you want to come to this retreat? *

Do you have any previous experience with shamanic plants, with shamans, or in ayahuasca retreats? When and Where?

Diet * veganvegetarianmeat, chicken, fishdifferent

Food allergies and restrictions

Step 3: Health Information

How do you handle crises? Explain: *

Describe personal and/or family history of depression, psychological disorders or imbalances, suicidal thoughts. *

Are you currently taking any kind of medication and/or supplements? *

Do you or a family member have a history with substances or addictions? * Explain:

Have you ever been hospitalized? *

Health insurance for travel - company and policy number:

Step 4: Reservation Information

Date *

How did you learn about us? *

Any other comments?

All form details are saved when you click a button above, ensure you have entered the correct email address so we can contact you the next day if the application was not submitted successfully. Press Next to proceed to the next step and Send on the last step to submit.