APPLY TO THE PERU RETREAT

Name *

First

Last

Email *

Phone number *

Occupation/Education *

How did you find out about the Embodied Transformation Retreat? *

Do you have any previous experience immersing yourself in nature? If so, please explain. *

Do you feel comfortable with primitive, simple living opened to the elements, plants, and animals of nature? *

Do you have any previous experience relating with indigenous cultures? *

What is your dietary lifestyle like? Do you have any dietary disciplines or restrictions we need to accommodate? *

Have you done any detoxing, cleansing, or fasting before? If so, what kind(s)? *

Do you have any allergies? If so, what are they? *

Are you currently taking any pharmaceutical or over-the-counter medications? *

Do you have any medical conditions, ailments, diseases, or disorders we need to know about (physically, mentally, emotionally, and spiritually)? *

Have you drank Ayahuasca before? If so, how many times, where, and how were your experience(s)? *

What are your intentions for this journey? What transformations do you want to see in your life, yourself, and your relationships? *

What special skills do you have that may be useful for the group logistically and creatively? *

Are you ready to make the energetic and financial investment in yourself to receive an experience of a lifetime? *

Is there anything else you would like to share with us?

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