Peru: a Pilgrimage to the Sacred Valley
September 4 - September 13, 2027
Registration Form
Thank you for filling out this form. Once we have received your registration, you will be contacted for deposit payment. Upon receipt of your deposit, you will receive a full Welcome Packet along with your email receipt.
Full Name
*
First Name
Last Name
Birth Date
*
 -
Month
 -
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
 -
Area Code
Phone Number
E-mail
*
example@example.com
Passport Requirements
Please apply for passports or passport renewals well in advance to ensure valid passports are available at least 60 days prior to the Retreat Start Date. This is a necessary deadline to fulfill vendor requirements in Peru.
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Personal Information
Thank you for answering the call to join this journey to the Sacred Valley of Peru. Your responses to the following questions will help Roxanna get to know you better and support the creation of a thoughtful and meaningful retreat experience for everyone in our circle.
What is calling you to this retreat in the Sacred Valley of Peru at this time in your life?
*
(Feel free to share anything that feels meaningful—curiosity, healing, adventure, spiritual exploration, or simply the desire to pause and connect.)
Food Sensitivities or Medical Conditions you would like us to know about:
*
Please share a little about your experience with yoga, meditation, or other contemplative or spiritual practices.
*
(All levels are welcome. This simply helps Roxanna understand how to best support the group.)
Is there anything you would like Roxanna to know about you—your intentions, hopes for the retreat, or anything that would help support your experience?
(optional)
Are you currently working with any teachers, therapists, or spiritual guides who support your personal growth?
Rates for Peru; a Pilgrimage to the Sacred Valley
September 4 - 13, 2027
Single Room or Shared Occupancy
*
Shared Deluxe Room $3,950
Single Deluxe Room $5,050
Roommate Request
You do not need to have a roommate in mind, we will pair you with an appropriate match.
San Pedro Extension: September 2 - 4, 2027
Participation in the San Pedro ceremonial experience is a sacred and intentional process. For those interested in joining this optional portion of the retreat, participation will be confirmed after a brief phone conversation with Roxanna. This allows time to connect personally, answer questions, and ensure the experience is aligned and supportive for you.
Are you interested in participating in the San Pedro Extension?
*
Yes
No
Not Sure
Liability Waiver, Terms, and Conditions
Payment Policy
A $500 non-refundable deposit is required to reserve your spot. You may either pay in full or divide your balance into 3 scheduled payments. If you are making scheduled payments, the list of dates are as follows: 07/01/2026, 12/01/2026 & 5/01/27. We accept Venmo, Zelle, and personal check. Venmo: @Roxanna-Smith-2, Zelle: roxanna.smith@gmail.com
Payment Plans Available
If you would like to set up a payment plan, please contact us. We are happy to work with you. Payment is due in full on or before May 1, 2027.
Cancellation Policy:
Cancellations after registration will be refunded at 50%, minus the non-refundable deposit payment of $500. Cancellations within 120 days of departure are non-refundable. All cancellations must be in writing and sent via email. There is no refund for any unused portions of the tour, including but not limited to missed meals, hotel nights and sightseeing. Tour rates do not include airfare to Peru. You will need a valid passport (with at least 6 months until expiration) to travel in Peru.
Travel Insurance:
Because this retreat involves international travel and significant advance planning, comprehensive travel insurance is STRONGLY recommended for all participants. Travel insurance can protect you in the event of unexpected trip cancellation, travel delays, medical needs while abroad, or emergency evacuation. Please note that retreat payments are non-refundable within the stated cancellation window, and unforeseen circumstances such as illness, family emergencies, or travel disruptions can arise. For this reason, securing travel insurance that includes both trip cancellation and medical coverage is an important safeguard for your investment and your well-being. Participants are responsible for arranging their own insurance coverage, and it is highly recommended that this be purchased soon after registering for the retreat. We recommend SquareMouth Travel Insurance; www.squaremouth.com
Force Majeure / Unforeseen Circumstances:
In the event that the retreat is canceled due to circumstances beyond our control (including but not limited to natural disasters, government restrictions, acts of war, pandemics, or other force majeure events), refunds will be issued to the extent that funds are recoverable from our partners, vendors, and service providers.We strongly recommend purchasing comprehensive travel insurance to protect your investment in the event of trip interruption, cancellation, or delay.
Limitation of Liability:
In order to be able to continue providing the best possible service to you and our participants, we need to protect ourselves: Roxanna Kopp Smith will not be liable and shall not be held responsible for any direct or indirect loss or damage to baggage or property, or for personal injury or death, delay or inconvenience in connection with the provision of, or failure to provide, any goods or services resulting from acts, omissions, or negligence of any third party provider of services or accommodations, or due to any other cause whatsoever beyond the direct control of Roxanna Kopp Smith. Roxanna Kopp Smith will further not be liable, and shall not be held responsible, for any loss, damage or additional expenses, delay or inconvenience caused by changes in schedule due to the actions, omissions or decisions of any carrier or other supplier of services, and/or disruptions to the schedule caused by, including without limitation, force majeure events, pandemics or public health crises, weather, strikes or civil unrest, political strife and demonstrations, mechanical or other failure of vessels and other means of transportation, reasonable health precautions, or any other reason whatsoever beyond the direct control of Roxanna Kopp Smith.
Waiver:
You as Participant agree that you engage in any and all activities at or during the retreat at your own risk, including, but not limited to, yoga, meditation, hiking, excursions, and any other activity or use of any facility on the premises of Willka Tikka Wellness. You as Participant also acknowledge that participation in the retreat carries with it certain risks, known and unknown, including the risk of personal injury and risks related to high altitude, and release Roxanna Kopp Smith and Willka Tikka Wellness (including its managers, officers, directors, instructors, employees, and agents) from their own negligence and any duty of reasonable care to protect the Retreat Leader / participant from injury.
By checking this box, I state my understanding and agreement with the waiver, terms, and conditions of this contract
*
I agree
Save
Submit
I look forward to connecting with you and walking this sacred journey together. 🌿
Should be Empty: