LHT Peru 2025 Registration Form

Peru: Sacred Sites and Shamanic Blessings

June 28 – July 7, 2025
Full Name (as it appears on your passport)*

First NameMiddle NameLast Name
Parent/Guardian Name (if filling out this form for a minor age 18 or younger)

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
E-mail*
Gender

FemaleMaleNon-binaryOther
Date of Birth*

MonthDayYear
Country of Birth*
Passport Information

Required for this trip if you are not a U.S. citizen
Country Issued
Passport Number
State Issued
Date of Issue

MonthDayYear
Date of Expiration

MonthDayYear
Emergency Contact Information
Name*

First NameLast Name
Relation*
Email*
Phone Number*
What Type of Accommodations Do You Want?*

Single - $4590 per personDouble - $3900 per personTriple - $3650 per person
Are you attending the Amazon add-on to Tambopata Reserve from July 7-10, 2025?*

YesNo
Should be Empty:

Peru: Sacred Sites and Shamanic Blessings