Inner Alchemy: Plants + Wisdom of Peru                    {June 15 - 24, 2024}
Thank you for your interest in joining us on our upcoming journey to Peru! We look forward to getting to know you better, and will be in touch with you soon! E-mail us with any questions at sageandmaizeretreats@gmail.com
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电子邮件地址 *
Full Name + Preferred First Name *
Phone or WhatsApp Number *
Date of Birth *
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Preferred Pronouns
How did you hear about this trip? *
Have you traveled internationally before? If so, where? *
Have you had experience with earth honoring practices? *
What is your level of botanical/herbal knowledge? *
What are your intentions/goals for participating in this herbal and cultural immersion? *
Are there any aspects of Peruvian culture or Q'ero practices that you are most drawn to? *
Check all options that apply to your diet *
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List any food/drug allergies or intolerances: *
Are you taking any medications? *
How often do you hike? *
Do you get car sick or experience motion sickness often? *
Do you have any physical ailments or other limitations? If so what are they?
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Do you have a history of asthma, chronic sinus infections or colds, or other respiratory illness?
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Do you have any mental health concerns that may affect your ability to participate in a group setting or in doing emotional healing work? This may also apply to concerns regarding working with various plant medicines.
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Do you have a history of any cardiac issues, stroke, aneurysm, or other potential health risks that may be aggravated by travel or high altitude?
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Have you been at high altitude before (over 8,000 ft)? If so, did you experience altitude sickness issues? *
Do you have a fear of heights or any other phobias? *
How flexible are you to change and unexpected circumstances? *
Do you speak Spanish? *
Do you consume alcohol? How frequently? *
Do you have experience with cannabis, San Pedro/wachuma or other entheogens? How frequently? *
Are you always on time or do you tend to run late? *
Are you interested in an optional day trip to Machu Picchu before the retreat? *
Are you interested in an optional 2-night trip to the sacred mountain, Apu Ausangate, after the retreat?
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Are you interested in a Private Room upgrade for an additional fee? (*Please note Private Room availability is not guaranteed until confirmed. All other rooms will be shared between two people and have an en-suite bathroom).
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What are the top 3 things you are looking forward to about this trip? *
Do you have any other comments, information or special instructions for us?
I agree to send a deposit in the amount of $600 to reserve my space. I accept that this deposit is non-refundable. To confirm your registration, please send your deposit of $600 via Zelle to sageandmaizeretreats@gmail.com *
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All participants must complete the waiver form linked HERE. Check below once this form has been completed.
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Emergency Contact Name/Number/Email *
By typing my full name below, I certify that all of the above statements are true and accurate to the best of my knowledge at the time of completion.
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