Formulario español

Selva Madre Ayahuasca Retreat Healing Center

Fill out the reservation form, Thank you.
Ayahuasca Retreats - Retiros de Ayahuasca*
Seleccione porfavor
Ayahuasca Retreat Prices per person

– 3 Days, 2 Nights – 2 Ayahuasca (USD $500)

- 4 Days, 3 nights - 2 ayahuasca (USD $750)
– 5 Days, 3 Nights – 3 Ayahuasca (USD $900)
– 7 Days, 6 Nights – 4 Ayahuasca (USD $1,200)
— 8 Days, 7 Nights – 4 Ayahuasca (USD $1,300)
— 10 Days, 9 Nights – 6 Ayahuasca (USD $1500)
— 15 Days, 14 Nights – 8 Ayahuasca (USD $2000)
— 21 Days, 20 Nights – 10 Ayahuasca (USD $3000)
Select your dates
Arrival date - Fecha de llegada*

MesDíaAño
Date
Departure date - Fecha de salida*

MesDíaAño
Date
Write your own days*
Escribe sus propias fechas
Contact - information*

NAME - NOMBRELASTNAME . APELLIDOS
WhatsApp Number
Age
Edad
Email*
Correo electronico
Country *
Pais
Gender - Sexo*

ManWoman
Emergency contact WhatsApp number*
contacto de emergencia
Dietary Restrictions
RESTRICCIONES DIETECIAS
Special Needs of Requirements
REQUISITOS DE NECESIDADES ESPECIALES
What are your expectations of the Ayahuasca Experience?
GUESTS*
Travel - viaja

SoloCouple (en pareja)Group (grupal)
If you have any other questions, please do not hesitate to write to us. If you have any changes to your arrival and departure flights, please notify us in advance. The company is not responsible for changes

We thank you for being part of this wonderful journey with

*Selva Madre Ayahuasca Retreat Healing Center*
E-Mails

contact@selvamadre.net

rimachiluis150@gmail.com
When we receive the reservation form , we will send a message by Email or WhatsApp for the confirmation and the payment methode.

Selva Madre Team
I agree to the Terms of Use and Privacy Policies*

i agree
Should be Empty:

Selva Madre Ayahuasca Retreat Healing Center

Select your dates