Retreat Application Form

Home of Ayahuasca

Licence № 074-2019-GRL-DIRCETURA-DET
Arica 772, Iquitos, Peru, 16000

Our Whatsapp: +51914399763, e-mail: [email protected]

Before submitting a request, please read the website materials.
Only individual retreats in independent mode.
To ensure the high quality of the retreat, we had to limit the number of participants. If you are planning to join our program, please make your reservations in advance.
If you haven't received a response within 24 hours, please check your Spam folder.

Your name, age, country *

Your E-Mail *

Your Whatsapp

How did you know about us?

Brief personal information: your goals, why you are going to retreat, what you want to achieve / change / realize *

Duration and dates of the retreat. Choosed plants (Ayahuasca, Chiric Sanango or Camalonga) *

Do you have / did you have any chronic diseases, allergy, serious injuries, surgery, drug / alcohol / other addictions? Do you use any medicaments? *

Did you have experience in interacting with Ayahuasca or other shamanic / healing plants? *

Do you practicise anything listed (self-development, health, spiritual, religious)?

I accept the Privacy Police. *