{"id":12555,"date":"2016-06-17T11:59:43","date_gmt":"2016-06-17T16:59:43","guid":{"rendered":"http:\/\/feathercrown.com\/?page_id=12555"},"modified":"2026-04-08T10:21:21","modified_gmt":"2026-04-08T15:21:21","slug":"registro","status":"publish","type":"page","link":"https:\/\/feathercrown.com\/es\/registration\/","title":{"rendered":"Formulario de inscripci\u00f3n para el retiro de Ayahuasca Feather Crown"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; admin_label=&#8221;section&#8221; _builder_version=&#8221;4.27.6&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_fullwidth_header title=&#8221;Ayahuasca Retreat Registration&#8221; text_orientation=&#8221;center&#8221; admin_label=&#8221;13-day retreat with four Ayahuasca ceremonies in Ecuador&#8221; _builder_version=&#8221;4.27.6&#8243; title_text_align=&#8221;center&#8221; background_color=&#8221;rgba(0,0,0,0.47)&#8221; 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global_colors_info=&#8221;{}&#8221;]<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Ayahuasca retreat Registration form<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/es\/wp-json\/wp\/v2\/pages\/12555' data-formid='1' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the length of your retreat:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_52'>\n\t\t\t<li class='gchoice gchoice_1_52_0'>\n\t\t\t\t<input name='input_52' type='radio' value='5-day short retreat'  id='choice_1_52_0'    \/>\n\t\t\t\t<label for='choice_1_52_0' id='label_1_52_0' class='gform-field-label gform-field-label--type-inline'>5-day short retreat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_52_1'>\n\t\t\t\t<input name='input_52' type='radio' value='10-day full immersive retreat'  id='choice_1_52_1'    \/>\n\t\t\t\t<label for='choice_1_52_1' id='label_1_52_1' class='gform-field-label gform-field-label--type-inline'>10-day full immersive retreat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_52_2'>\n\t\t\t\t<input name='input_52' type='radio' value='30-day traditional Shipibo dieta'  id='choice_1_52_2'    \/>\n\t\t\t\t<label for='choice_1_52_2' id='label_1_52_2' class='gform-field-label gform-field-label--type-inline'>30-day traditional Shipibo dieta<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the event you wish to book:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_43'>Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_43'>\n\t\t\t<li class='gchoice gchoice_1_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='August 10 - 19, 2026 (10 days) $1790 - Ceremonies led by Don Carlos'  id='choice_1_43_0'    \/>\n\t\t\t\t<label for='choice_1_43_0' id='label_1_43_0' class='gform-field-label gform-field-label--type-inline'>August 10 - 19, 2026 (10 days) $1790 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='October 5 - 14, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_1'    \/>\n\t\t\t\t<label for='choice_1_43_1' id='label_1_43_1' class='gform-field-label gform-field-label--type-inline'>October 5 - 14, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='October 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_2'    \/>\n\t\t\t\t<label for='choice_1_43_2' id='label_1_43_2' class='gform-field-label gform-field-label--type-inline'>October 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_3'>\n\t\t\t\t<input name='input_43' type='radio' value='November 23 - December 2, 2026 (10 days) $1790 - Ceremonies led by Don Carlos'  id='choice_1_43_3'    \/>\n\t\t\t\t<label for='choice_1_43_3' id='label_1_43_3' class='gform-field-label gform-field-label--type-inline'>November 23 - December 2, 2026 (10 days) $1790 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_4'>\n\t\t\t\t<input name='input_43' type='radio' value='January 11 - 20, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_4'    \/>\n\t\t\t\t<label for='choice_1_43_4' id='label_1_43_4' class='gform-field-label gform-field-label--type-inline'>January 11 - 20, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_5'>\n\t\t\t\t<input name='input_43' type='radio' value='January 28 - February 6, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_5'    \/>\n\t\t\t\t<label for='choice_1_43_5' id='label_1_43_5' class='gform-field-label gform-field-label--type-inline'>January 28 - February 6, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_6'>\n\t\t\t\t<input name='input_43' type='radio' value='February 13 - 22, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_6'    \/>\n\t\t\t\t<label for='choice_1_43_6' id='label_1_43_6' class='gform-field-label gform-field-label--type-inline'>February 13 - 22, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the event you wish to book:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_55'>Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_55'>\n\t\t\t<li class='gchoice gchoice_1_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='August 10 - 14, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_0'    \/>\n\t\t\t\t<label for='choice_1_55_0' id='label_1_55_0' class='gform-field-label gform-field-label--type-inline'>August 10 - 14, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='August 14 - 18, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_1'    \/>\n\t\t\t\t<label for='choice_1_55_1' id='label_1_55_1' class='gform-field-label gform-field-label--type-inline'>August 14 - 18, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_2'>\n\t\t\t\t<input name='input_55' type='radio' value='October 5 - 9, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_2'    \/>\n\t\t\t\t<label for='choice_1_55_2' id='label_1_55_2' class='gform-field-label gform-field-label--type-inline'>October 5 - 9, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_3'>\n\t\t\t\t<input name='input_55' type='radio' value='October 9 - 13, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_3'    \/>\n\t\t\t\t<label for='choice_1_55_3' id='label_1_55_3' class='gform-field-label gform-field-label--type-inline'>October 9 - 13, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_4'>\n\t\t\t\t<input name='input_55' type='radio' value='October 19 - 23, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_4'    \/>\n\t\t\t\t<label for='choice_1_55_4' id='label_1_55_4' class='gform-field-label gform-field-label--type-inline'>October 19 - 23, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_5'>\n\t\t\t\t<input name='input_55' type='radio' value='October 23 - 27, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_5'    \/>\n\t\t\t\t<label for='choice_1_55_5' id='label_1_55_5' class='gform-field-label gform-field-label--type-inline'>October 23 - 27, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_6'>\n\t\t\t\t<input name='input_55' type='radio' value='November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_6'    \/>\n\t\t\t\t<label for='choice_1_55_6' id='label_1_55_6' class='gform-field-label gform-field-label--type-inline'>November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_7'>\n\t\t\t\t<input name='input_55' type='radio' value='November 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_7'    \/>\n\t\t\t\t<label for='choice_1_55_7' id='label_1_55_7' class='gform-field-label gform-field-label--type-inline'>November 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_8'>\n\t\t\t\t<input name='input_55' type='radio' value='January 28 - February 1, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_8'    \/>\n\t\t\t\t<label for='choice_1_55_8' id='label_1_55_8' class='gform-field-label gform-field-label--type-inline'>January 28 - February 1, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_9'>\n\t\t\t\t<input name='input_55' type='radio' value='February 1 - 5, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_9'    \/>\n\t\t\t\t<label for='choice_1_55_9' id='label_1_55_9' class='gform-field-label gform-field-label--type-inline'>February 1 - 5, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_10'>\n\t\t\t\t<input name='input_55' type='radio' value='February 13 - 17, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_10'    \/>\n\t\t\t\t<label for='choice_1_55_10' id='label_1_55_10' class='gform-field-label gform-field-label--type-inline'>February 13 - 17, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_11'>\n\t\t\t\t<input name='input_55' type='radio' value='February 17 - 21, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_11'    \/>\n\t\t\t\t<label for='choice_1_55_11' id='label_1_55_11' class='gform-field-label gform-field-label--type-inline'>February 17 - 21, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the event you wish to book:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_54'>Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_54'>\n\t\t\t<li class='gchoice 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id='choice_1_54_2'    \/>\n\t\t\t\t<label for='choice_1_54_2' id='label_1_54_2' class='gform-field-label gform-field-label--type-inline'>January 28 \u2013 February 28, 2027 (30 days) $3700 - Led by Shipibo Maestro Sina<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_49\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Deposit non-refundability and even cancellation akcnowledgement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_49'><li class='gchoice gchoice_1_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='I am aware that the booking deposit is &lt;b&gt;non-refundable&lt;\/b&gt;. However any deposit &lt;b&gt;can be transferred&lt;\/b&gt; to another date if done at least 30 days before the originally booked event begins. The deposit can also be transfrerred to another person for free any time. In case the even in cancelled, the organizer issues a full refund of any depodsits, but is not responsible for covering any losses due to event being cancelled. In order to prevent any losses, a travel insurance or refundable flight tariff is recommended.'  id='choice_1_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_1' id='label_1_49_1' class='gform-field-label gform-field-label--type-inline'>I am aware that the booking deposit is <b>non-refundable<\/b>. However any deposit <b>can be transferred<\/b> to another date if done at least 30 days before the originally booked event begins. The deposit can also be transfrerred to another person for free any time. In case the even in cancelled, the organizer issues a full refund of any depodsits, but is not responsible for covering any losses due to event being cancelled. In order to prevent any losses, a travel insurance or refundable flight tariff is recommended.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_29\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Basic information<\/h2><\/li><li id=\"field_1_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Your name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>Name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_2_container'>\n                                <span id='input_1_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2' id='input_1_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_2' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_1_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2_2' id='input_1_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_1_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Gender:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_8'>\n\t\t\t<li class='gchoice gchoice_1_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Male'  id='choice_1_8_0'    \/>\n\t\t\t\t<label for='choice_1_8_0' id='label_1_8_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='Female'  id='choice_1_8_1'    \/>\n\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_9'>Age:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Residency<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_city has_country ginput_container_address gform-grid-row' id='input_1_6' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_1_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_6_3' id='input_1_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_1_6_4' value=''\/><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_6_6_container' >\n                                        <select name='input_6.6' id='input_1_6_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_1_6_6' id='input_1_6_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'>Passport number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_5\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_5'>If you don't have your passport yet, please fill \"0\" and give us your passport number later.<\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'>Emergency contact (name, phone number):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Health condition<\/h2><\/li><li id=\"field_1_14\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_14'>What is your current health condition?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_1_14' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_51\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Do you currently suffer from any of the following health conditions?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_51'><li class='gchoice gchoice_1_51_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.1' type='checkbox'  value='very high blood pressure'  id='choice_1_51_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_1' id='label_1_51_1' class='gform-field-label gform-field-label--type-inline'>very high blood pressure<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.2' type='checkbox'  value='severe diabetes'  id='choice_1_51_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_2' id='label_1_51_2' class='gform-field-label gform-field-label--type-inline'>severe diabetes<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.3' type='checkbox'  value='schizophrenic disorder'  id='choice_1_51_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_3' id='label_1_51_3' class='gform-field-label gform-field-label--type-inline'>schizophrenic disorder<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.4' type='checkbox'  value='heart disease or any condition previously diagnosed indicating vulnerability to the heart'  id='choice_1_51_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_4' id='label_1_51_4' class='gform-field-label gform-field-label--type-inline'>heart disease or any condition previously diagnosed indicating vulnerability to the heart<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.5' type='checkbox'  value='epilepsy and other seizure related conditions'  id='choice_1_51_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_5' id='label_1_51_5' class='gform-field-label gform-field-label--type-inline'>epilepsy and other seizure related conditions<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.6' type='checkbox'  value='infectious or contagious disease'  id='choice_1_51_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_6' id='label_1_51_6' class='gform-field-label gform-field-label--type-inline'>infectious or contagious disease<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.7' type='checkbox'  value='suicidal ideation'  id='choice_1_51_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_7' id='label_1_51_7' class='gform-field-label gform-field-label--type-inline'>suicidal ideation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.8' type='checkbox'  value='use of MAO inhibitors or anti-psychotic medication'  id='choice_1_51_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_8' id='label_1_51_8' class='gform-field-label gform-field-label--type-inline'>use of MAO inhibitors or anti-psychotic medication<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.9' type='checkbox'  value='mental illness'  id='choice_1_51_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_9' id='label_1_51_9' class='gform-field-label gform-field-label--type-inline'>mental illness<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.11' type='checkbox'  value='drug addiction'  id='choice_1_51_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_11' id='label_1_51_11' class='gform-field-label gform-field-label--type-inline'>drug addiction<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.12' type='checkbox'  value='diagnosed terminal illness such as cancer'  id='choice_1_51_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_12' id='label_1_51_12' class='gform-field-label gform-field-label--type-inline'>diagnosed terminal illness such as cancer<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'>Any medicines or supplements that you are currently using:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_16' id='input_1_16' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_17\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_17'>Allergies:<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_1_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_33'>Please list any recreational drugs you are using regularly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_1_33' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_33\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_33'>Enter \"none\" if you are not currently using any recreational drugs.<\/div><\/li><li id=\"field_1_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you currently pregnant?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_35'>\n\t\t\t<li class='gchoice gchoice_1_35_0'>\n\t\t\t\t<input name='input_35' type='radio' value='Yes'  id='choice_1_35_0'    \/>\n\t\t\t\t<label for='choice_1_35_0' id='label_1_35_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_1'>\n\t\t\t\t<input name='input_35' type='radio' value='No'  id='choice_1_35_1'    \/>\n\t\t\t\t<label for='choice_1_35_1' id='label_1_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_35'>I understand that ayahuasca and all other sacred plants are purgatives and dangerous to consume while pregnant. If I become pregnant before the beginning of the tour, I understand that I am responsible for notifying Feather Crown and that I will not be able to ingest ayahuasca or any other sacred plant during pregnancy. I also understand that I will not be entitled to a refund.<\/div><\/li><li id=\"field_1_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Feather Crown Health Screening and Full Disclosure:<\/h2><\/li><li id=\"field_1_36\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox ginput_container gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >No supplements, no medications&quot; policy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_36'>This retreat involves the ingestion of plant medicines that may be contraindicated with certain medical conditions, medications, or substances.\n\nAll herbal supplements, natural medicines, and medications (prescription and over-the-counter) taken within 30 days prior to the retreat, as well as during the retreat, must be fully disclosed to Feather Crown before the retreat begins.\n\nNo medications, supplements, or natural remedies may be taken during the retreat without the express written permission of Feather Crown.\n\nBy completing this application, you confirm that all information provided is true, complete, and current, and that you have fully disclosed all physical and psychological conditions, as well as all medications, supplements, and substances you are taking.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_36'><li class='gchoice gchoice_1_36_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.1' type='checkbox'  value='I agree to the Feather Crown Health Screening and Full Disclosure'  id='choice_1_36_1'   aria-describedby=\"gfield_description_1_36\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_1' id='label_1_36_1' class='gform-field-label gform-field-label--type-inline'>I agree to the Feather Crown Health Screening and Full Disclosure<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_46\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Feather Crown Medical Responsibility and Liability Waiver<\/h2><\/li><li id=\"field_1_37\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >By checking the box below and typing my name, I confirm that:\n\nI have read and understood all provided medical and safety information\nI have fully disclosed all requested health and medical information\nAll information I have provided is true and complete to the best of my knowledge\n\nI understand that:\n\nFalsifying or omitting relevant information may result in denial of participation, with or without refund, at the sole discretion of Feather Crown\nAyahuasca and other plant medicines may be dangerous or life-threatening if combined with certain conditions or substances\nFeather Crown is not a medical facility\nIts owners, staff, employees, and agents do not practice Western medicine and are not licensed medical doctors\n\nI voluntarily assume full responsibility for my participation.\n\nI hereby waive, release, and hold harmless Feather Crown, its owners, staff, employees, and agents from any and all liability, claims, damages, or injuries that may occur in connection with my participation.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_37'>By checking the box below and typing my name, I confirm that:\n\nI have read and understood all provided medical and safety information\nI have fully disclosed all requested health and medical information\nAll information I have provided is true and complete to the best of my knowledge\n\nI understand that:\n\nFalsifying or omitting relevant information may result in denial of participation, with or without refund, at the sole discretion of Feather Crown\nAyahuasca and other plant medicines may be dangerous or life-threatening if combined with certain conditions or substances\nFeather Crown is not a medical facility\nIts owners, staff, employees, and agents do not practice Western medicine and are not licensed medical doctors\n\nI voluntarily assume full responsibility for my participation.\n\nI hereby waive, release, and hold harmless Feather Crown, its owners, staff, employees, and agents from any and all liability, claims, damages, or injuries that may occur in connection with my participation.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_37'><li class='gchoice gchoice_1_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='I have read, understood, and agree to the Medical Responsibility and Liability Waiver'  id='choice_1_37_1'   aria-describedby=\"gfield_description_1_37\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_37_1' id='label_1_37_1' class='gform-field-label gform-field-label--type-inline'>I have read, understood, and agree to the Medical Responsibility and Liability Waiver<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_27'>Please type your name in CAPITAL letters:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_1_27' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Food, accommodation and transportation<\/h2><\/li><li id=\"field_1_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Preferred diet:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_18'>\n\t\t\t<li class='gchoice gchoice_1_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Normal'  id='choice_1_18_0'    \/>\n\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>Normal<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='Vegetarian'  id='choice_1_18_1'    \/>\n\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>Vegetarian<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_2'>\n\t\t\t\t<input name='input_18' type='radio' value='Vegetarian eating fish'  id='choice_1_18_2'    \/>\n\t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'>Vegetarian eating fish<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_3'>\n\t\t\t\t<input name='input_18' type='radio' value='Vegan'  id='choice_1_18_3'    \/>\n\t\t\t\t<label for='choice_1_18_3' id='label_1_18_3' class='gform-field-label gform-field-label--type-inline'>Vegan<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_19\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_19'>Any special requirements for your diet?<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_1_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Preffered type of accommodation:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_20'>\n\t\t\t<li class='gchoice gchoice_1_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Private room for 1 person' checked='checked' id='choice_1_20_0'    \/>\n\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0' class='gform-field-label gform-field-label--type-inline'>Private room for 1 person<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='Private Room for 2 people (2 beds) shared among friends or family'  id='choice_1_20_1'    \/>\n\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>Private Room for 2 people (2 beds) shared among friends or family<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_13\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_13'>Let us know if there is somebody specific you want to share your room with:<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_1_13' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_47\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Private transport from Quito\/airport<\/label><div class='gfield_description' id='gfield_description_1_47'>Please check the following fields if you want us to organize private transport for you on the 1st day of the retreat, and\/or the last one. We can pick you up at your hotel in Quito, or at the Mariscal Sucre airport near Quito, or in Tababela (a town close to the airport). Please note that the price may differ according to how many people are requesting transport, but will not exceed $120 USD per person.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_47'><li class='gchoice gchoice_1_47_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.1' type='checkbox'  value='Quito\/aiport -&gt; Feather Crown ($50 USD per person, departure 8-9 AM)'  id='choice_1_47_1'   aria-describedby=\"gfield_description_1_47\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_1' id='label_1_47_1' class='gform-field-label gform-field-label--type-inline'>Quito\/aiport -&gt; Feather Crown ($50 USD per person, departure 8-9 AM)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_47_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.2' type='checkbox'  value='Feather Crown -&gt; Quito\/airport ($50 USD per person, departure 9:00 AM)'  id='choice_1_47_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_2' id='label_1_47_2' class='gform-field-label gform-field-label--type-inline'>Feather Crown -&gt; Quito\/airport ($50 USD per person, departure 9:00 AM)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Work with the plants<\/h2><\/li><li id=\"field_1_21\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_21'>Do you have any previous experience with Ayahuasca? If yes, what were the results?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_1_21' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_22\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>What would you like to achieve and what are your expectations?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_1_22' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_23\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_23'>Referral (first time guests only)<\/label><div class='gfield_description' id='gfield_description_1_23'>How did you hear about Feather Crown? If it was from a website, which one? Thank you for helping us to understand how people find us.<\/div><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_23\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_24'>Message to the organizers:<\/label><div class='gfield_description' id='gfield_description_1_24'>Anything that you want to add:<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_1_24' class='textarea medium'  aria-describedby=\"gfield_description_1_24\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_50\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Make sure we receive your registration:<\/h2><div class='gsection_description' id='gfield_description_1_50'>After you hit the submit button, you should receive an immediate confirmation email. If you don't receive the confirmation email within few minutes, something went wrong with your submission and you need to resend it. Make sure you fill all the obligatory fields, otherwise it won't let you send the form. You can always contact us at info@feathercrown.com if you have any problem.<\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit registration form'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            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 action='\/es\/wp-json\/wp\/v2\/pages\/12555' data-formid='1' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_1_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the length of your retreat:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_52'>\n\t\t\t<li class='gchoice gchoice_1_52_0'>\n\t\t\t\t<input name='input_52' type='radio' value='5-day short retreat'  id='choice_1_52_0'    \/>\n\t\t\t\t<label for='choice_1_52_0' id='label_1_52_0' class='gform-field-label gform-field-label--type-inline'>5-day short retreat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_52_1'>\n\t\t\t\t<input name='input_52' type='radio' value='10-day full immersive retreat'  id='choice_1_52_1'    \/>\n\t\t\t\t<label for='choice_1_52_1' id='label_1_52_1' class='gform-field-label gform-field-label--type-inline'>10-day full immersive retreat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_52_2'>\n\t\t\t\t<input name='input_52' type='radio' value='30-day traditional Shipibo dieta'  id='choice_1_52_2'    \/>\n\t\t\t\t<label for='choice_1_52_2' id='label_1_52_2' class='gform-field-label gform-field-label--type-inline'>30-day traditional Shipibo dieta<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the event you wish to book:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_43'>Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_43'>\n\t\t\t<li class='gchoice gchoice_1_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='August 10 - 19, 2026 (10 days) $1790 - Ceremonies led by Don Carlos'  id='choice_1_43_0'    \/>\n\t\t\t\t<label for='choice_1_43_0' id='label_1_43_0' class='gform-field-label gform-field-label--type-inline'>August 10 - 19, 2026 (10 days) $1790 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='October 5 - 14, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_1'    \/>\n\t\t\t\t<label for='choice_1_43_1' id='label_1_43_1' class='gform-field-label gform-field-label--type-inline'>October 5 - 14, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='October 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_2'    \/>\n\t\t\t\t<label for='choice_1_43_2' id='label_1_43_2' class='gform-field-label gform-field-label--type-inline'>October 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_3'>\n\t\t\t\t<input name='input_43' type='radio' value='November 23 - December 2, 2026 (10 days) $1790 - Ceremonies led by Don Carlos'  id='choice_1_43_3'    \/>\n\t\t\t\t<label for='choice_1_43_3' id='label_1_43_3' class='gform-field-label gform-field-label--type-inline'>November 23 - December 2, 2026 (10 days) $1790 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_4'>\n\t\t\t\t<input name='input_43' type='radio' value='January 11 - 20, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_4'    \/>\n\t\t\t\t<label for='choice_1_43_4' id='label_1_43_4' class='gform-field-label gform-field-label--type-inline'>January 11 - 20, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_5'>\n\t\t\t\t<input name='input_43' type='radio' value='January 28 - February 6, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_5'    \/>\n\t\t\t\t<label for='choice_1_43_5' id='label_1_43_5' class='gform-field-label gform-field-label--type-inline'>January 28 - February 6, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_6'>\n\t\t\t\t<input name='input_43' type='radio' value='February 13 - 22, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)'  id='choice_1_43_6'    \/>\n\t\t\t\t<label for='choice_1_43_6' id='label_1_43_6' class='gform-field-label gform-field-label--type-inline'>February 13 - 22, 2027 (10 days) $1790 - Ceremonies led by Maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the event you wish to book:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_55'>Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_55'>\n\t\t\t<li class='gchoice gchoice_1_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='August 10 - 14, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_0'    \/>\n\t\t\t\t<label for='choice_1_55_0' id='label_1_55_0' class='gform-field-label gform-field-label--type-inline'>August 10 - 14, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='August 14 - 18, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_1'    \/>\n\t\t\t\t<label for='choice_1_55_1' id='label_1_55_1' class='gform-field-label gform-field-label--type-inline'>August 14 - 18, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_2'>\n\t\t\t\t<input name='input_55' type='radio' value='October 5 - 9, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_2'    \/>\n\t\t\t\t<label for='choice_1_55_2' id='label_1_55_2' class='gform-field-label gform-field-label--type-inline'>October 5 - 9, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_3'>\n\t\t\t\t<input name='input_55' type='radio' value='October 9 - 13, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_3'    \/>\n\t\t\t\t<label for='choice_1_55_3' id='label_1_55_3' class='gform-field-label gform-field-label--type-inline'>October 9 - 13, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_4'>\n\t\t\t\t<input name='input_55' type='radio' value='October 19 - 23, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_4'    \/>\n\t\t\t\t<label for='choice_1_55_4' id='label_1_55_4' class='gform-field-label gform-field-label--type-inline'>October 19 - 23, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_5'>\n\t\t\t\t<input name='input_55' type='radio' value='October 23 - 27, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_5'    \/>\n\t\t\t\t<label for='choice_1_55_5' id='label_1_55_5' class='gform-field-label gform-field-label--type-inline'>October 23 - 27, 2026 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_6'>\n\t\t\t\t<input name='input_55' type='radio' value='November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_6'    \/>\n\t\t\t\t<label for='choice_1_55_6' id='label_1_55_6' class='gform-field-label gform-field-label--type-inline'>November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_7'>\n\t\t\t\t<input name='input_55' type='radio' value='November 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos'  id='choice_1_55_7'    \/>\n\t\t\t\t<label for='choice_1_55_7' id='label_1_55_7' class='gform-field-label gform-field-label--type-inline'>November 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_8'>\n\t\t\t\t<input name='input_55' type='radio' value='January 28 - February 1, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_8'    \/>\n\t\t\t\t<label for='choice_1_55_8' id='label_1_55_8' class='gform-field-label gform-field-label--type-inline'>January 28 - February 1, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_9'>\n\t\t\t\t<input name='input_55' type='radio' value='February 1 - 5, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_9'    \/>\n\t\t\t\t<label for='choice_1_55_9' id='label_1_55_9' class='gform-field-label gform-field-label--type-inline'>February 1 - 5, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_10'>\n\t\t\t\t<input name='input_55' type='radio' value='February 13 - 17, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_10'    \/>\n\t\t\t\t<label for='choice_1_55_10' id='label_1_55_10' class='gform-field-label gform-field-label--type-inline'>February 13 - 17, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_11'>\n\t\t\t\t<input name='input_55' type='radio' value='February 17 - 21, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  id='choice_1_55_11'    \/>\n\t\t\t\t<label for='choice_1_55_11' id='label_1_55_11' class='gform-field-label gform-field-label--type-inline'>February 17 - 21, 2027 (5 days) $890 - Ceremonies led by Maestro Sina<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Select the event you wish to book:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_54'>Note: If you select an event which is currently full, you will be placed into its waiting list and notified when a space frees up.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_54'>\n\t\t\t<li class='gchoice gchoice_1_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='October 5 \u2013 November 5, 2026 (30 days) $3700 - Led by Shipibo Maestro Sina'  id='choice_1_54_0'    \/>\n\t\t\t\t<label for='choice_1_54_0' id='label_1_54_0' class='gform-field-label gform-field-label--type-inline'>October 5 \u2013 November 5, 2026 (30 days) $3700 - Led by Shipibo Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='January 11 \u2013 February 11, 2027 (30 days) $3700 - Led by Shipibo Maestro Sina'  id='choice_1_54_1'    \/>\n\t\t\t\t<label for='choice_1_54_1' id='label_1_54_1' class='gform-field-label gform-field-label--type-inline'>January 11 \u2013 February 11, 2027 (30 days) $3700 - Led by Shipibo Maestro Sina<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_54_2'>\n\t\t\t\t<input name='input_54' type='radio' value='January 28 \u2013 February 28, 2027 (30 days) $3700 - Led by Shipibo Maestro Sina'  id='choice_1_54_2'    \/>\n\t\t\t\t<label for='choice_1_54_2' id='label_1_54_2' class='gform-field-label gform-field-label--type-inline'>January 28 \u2013 February 28, 2027 (30 days) $3700 - Led by Shipibo Maestro Sina<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_49\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Deposit non-refundability and even cancellation akcnowledgement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_49'><li class='gchoice gchoice_1_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='I am aware that the booking deposit is &lt;b&gt;non-refundable&lt;\/b&gt;. However any deposit &lt;b&gt;can be transferred&lt;\/b&gt; to another date if done at least 30 days before the originally booked event begins. The deposit can also be transfrerred to another person for free any time. In case the even in cancelled, the organizer issues a full refund of any depodsits, but is not responsible for covering any losses due to event being cancelled. In order to prevent any losses, a travel insurance or refundable flight tariff is recommended.'  id='choice_1_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_1' id='label_1_49_1' class='gform-field-label gform-field-label--type-inline'>I am aware that the booking deposit is <b>non-refundable<\/b>. However any deposit <b>can be transferred<\/b> to another date if done at least 30 days before the originally booked event begins. The deposit can also be transfrerred to another person for free any time. In case the even in cancelled, the organizer issues a full refund of any depodsits, but is not responsible for covering any losses due to event being cancelled. In order to prevent any losses, a travel insurance or refundable flight tariff is recommended.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_29\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Basic information<\/h2><\/li><li id=\"field_1_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Your name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>Name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_2_container'>\n                                <span id='input_1_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2' id='input_1_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_2' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_1_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2_2' id='input_1_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_1_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Gender:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_8'>\n\t\t\t<li class='gchoice gchoice_1_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Male'  id='choice_1_8_0'    \/>\n\t\t\t\t<label for='choice_1_8_0' id='label_1_8_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='Female'  id='choice_1_8_1'    \/>\n\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_9'>Age:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Residency<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_city has_country ginput_container_address gform-grid-row' id='input_1_6' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_1_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_6_3' id='input_1_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_1_6_4' value=''\/><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_6_6_container' >\n                                        <select name='input_6.6' id='input_1_6_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_1_6_6' id='input_1_6_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'>Passport number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_1_5' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_5\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_5'>If you don't have your passport yet, please fill \"0\" and give us your passport number later.<\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'>Emergency contact (name, phone number):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Health condition<\/h2><\/li><li id=\"field_1_14\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_14'>What is your current health condition?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_1_14' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_51\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Do you currently suffer from any of the following health conditions?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_51'><li class='gchoice gchoice_1_51_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.1' type='checkbox'  value='very high blood pressure'  id='choice_1_51_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_1' id='label_1_51_1' class='gform-field-label gform-field-label--type-inline'>very high blood pressure<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.2' type='checkbox'  value='severe diabetes'  id='choice_1_51_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_2' id='label_1_51_2' class='gform-field-label gform-field-label--type-inline'>severe diabetes<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.3' type='checkbox'  value='schizophrenic disorder'  id='choice_1_51_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_3' id='label_1_51_3' class='gform-field-label gform-field-label--type-inline'>schizophrenic disorder<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.4' type='checkbox'  value='heart disease or any condition previously diagnosed indicating vulnerability to the heart'  id='choice_1_51_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_4' id='label_1_51_4' class='gform-field-label gform-field-label--type-inline'>heart disease or any condition previously diagnosed indicating vulnerability to the heart<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.5' type='checkbox'  value='epilepsy and other seizure related conditions'  id='choice_1_51_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_5' id='label_1_51_5' class='gform-field-label gform-field-label--type-inline'>epilepsy and other seizure related conditions<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.6' type='checkbox'  value='infectious or contagious disease'  id='choice_1_51_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_6' id='label_1_51_6' class='gform-field-label gform-field-label--type-inline'>infectious or contagious disease<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.7' type='checkbox'  value='suicidal ideation'  id='choice_1_51_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_7' id='label_1_51_7' class='gform-field-label gform-field-label--type-inline'>suicidal ideation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.8' type='checkbox'  value='use of MAO inhibitors or anti-psychotic medication'  id='choice_1_51_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_8' id='label_1_51_8' class='gform-field-label gform-field-label--type-inline'>use of MAO inhibitors or anti-psychotic medication<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.9' type='checkbox'  value='mental illness'  id='choice_1_51_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_9' id='label_1_51_9' class='gform-field-label gform-field-label--type-inline'>mental illness<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.11' type='checkbox'  value='drug addiction'  id='choice_1_51_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_11' id='label_1_51_11' class='gform-field-label gform-field-label--type-inline'>drug addiction<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_51_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.12' type='checkbox'  value='diagnosed terminal illness such as cancer'  id='choice_1_51_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_51_12' id='label_1_51_12' class='gform-field-label gform-field-label--type-inline'>diagnosed terminal illness such as cancer<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'>Any medicines or supplements that you are currently using:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_16' id='input_1_16' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_17\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_17'>Allergies:<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_1_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_33'>Please list any recreational drugs you are using regularly:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_1_33' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_33\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_33'>Enter \"none\" if you are not currently using any recreational drugs.<\/div><\/li><li id=\"field_1_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you currently pregnant?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_35'>\n\t\t\t<li class='gchoice gchoice_1_35_0'>\n\t\t\t\t<input name='input_35' type='radio' value='Yes'  id='choice_1_35_0'    \/>\n\t\t\t\t<label for='choice_1_35_0' id='label_1_35_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_1'>\n\t\t\t\t<input name='input_35' type='radio' value='No'  id='choice_1_35_1'    \/>\n\t\t\t\t<label for='choice_1_35_1' id='label_1_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_35'>I understand that ayahuasca and all other sacred plants are purgatives and dangerous to consume while pregnant. If I become pregnant before the beginning of the tour, I understand that I am responsible for notifying Feather Crown and that I will not be able to ingest ayahuasca or any other sacred plant during pregnancy. I also understand that I will not be entitled to a refund.<\/div><\/li><li id=\"field_1_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Feather Crown Health Screening and Full Disclosure:<\/h2><\/li><li id=\"field_1_36\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox ginput_container gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >No supplements, no medications&quot; policy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_36'>This retreat involves the ingestion of plant medicines that may be contraindicated with certain medical conditions, medications, or substances.\n\nAll herbal supplements, natural medicines, and medications (prescription and over-the-counter) taken within 30 days prior to the retreat, as well as during the retreat, must be fully disclosed to Feather Crown before the retreat begins.\n\nNo medications, supplements, or natural remedies may be taken during the retreat without the express written permission of Feather Crown.\n\nBy completing this application, you confirm that all information provided is true, complete, and current, and that you have fully disclosed all physical and psychological conditions, as well as all medications, supplements, and substances you are taking.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_36'><li class='gchoice gchoice_1_36_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.1' type='checkbox'  value='I agree to the Feather Crown Health Screening and Full Disclosure'  id='choice_1_36_1'   aria-describedby=\"gfield_description_1_36\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_1' id='label_1_36_1' class='gform-field-label gform-field-label--type-inline'>I agree to the Feather Crown Health Screening and Full Disclosure<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_46\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Feather Crown Medical Responsibility and Liability Waiver<\/h2><\/li><li id=\"field_1_37\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >By checking the box below and typing my name, I confirm that:\n\nI have read and understood all provided medical and safety information\nI have fully disclosed all requested health and medical information\nAll information I have provided is true and complete to the best of my knowledge\n\nI understand that:\n\nFalsifying or omitting relevant information may result in denial of participation, with or without refund, at the sole discretion of Feather Crown\nAyahuasca and other plant medicines may be dangerous or life-threatening if combined with certain conditions or substances\nFeather Crown is not a medical facility\nIts owners, staff, employees, and agents do not practice Western medicine and are not licensed medical doctors\n\nI voluntarily assume full responsibility for my participation.\n\nI hereby waive, release, and hold harmless Feather Crown, its owners, staff, employees, and agents from any and all liability, claims, damages, or injuries that may occur in connection with my participation.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_37'>By checking the box below and typing my name, I confirm that:\n\nI have read and understood all provided medical and safety information\nI have fully disclosed all requested health and medical information\nAll information I have provided is true and complete to the best of my knowledge\n\nI understand that:\n\nFalsifying or omitting relevant information may result in denial of participation, with or without refund, at the sole discretion of Feather Crown\nAyahuasca and other plant medicines may be dangerous or life-threatening if combined with certain conditions or substances\nFeather Crown is not a medical facility\nIts owners, staff, employees, and agents do not practice Western medicine and are not licensed medical doctors\n\nI voluntarily assume full responsibility for my participation.\n\nI hereby waive, release, and hold harmless Feather Crown, its owners, staff, employees, and agents from any and all liability, claims, damages, or injuries that may occur in connection with my participation.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_37'><li class='gchoice gchoice_1_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='I have read, understood, and agree to the Medical Responsibility and Liability Waiver'  id='choice_1_37_1'   aria-describedby=\"gfield_description_1_37\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_37_1' id='label_1_37_1' class='gform-field-label gform-field-label--type-inline'>I have read, understood, and agree to the Medical Responsibility and Liability Waiver<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_27'>Please type your name in CAPITAL letters:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_1_27' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Food, accommodation and transportation<\/h2><\/li><li id=\"field_1_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Preferred diet:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_18'>\n\t\t\t<li class='gchoice gchoice_1_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Normal'  id='choice_1_18_0'    \/>\n\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>Normal<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='Vegetarian'  id='choice_1_18_1'    \/>\n\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>Vegetarian<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_2'>\n\t\t\t\t<input name='input_18' type='radio' value='Vegetarian eating fish'  id='choice_1_18_2'    \/>\n\t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'>Vegetarian eating fish<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_3'>\n\t\t\t\t<input name='input_18' type='radio' value='Vegan'  id='choice_1_18_3'    \/>\n\t\t\t\t<label for='choice_1_18_3' id='label_1_18_3' class='gform-field-label gform-field-label--type-inline'>Vegan<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_19\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_19'>Any special requirements for your diet?<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_1_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Preffered type of accommodation:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_20'>\n\t\t\t<li class='gchoice gchoice_1_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Private room for 1 person' checked='checked' id='choice_1_20_0'    \/>\n\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0' class='gform-field-label gform-field-label--type-inline'>Private room for 1 person<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='Private Room for 2 people (2 beds) shared among friends or family'  id='choice_1_20_1'    \/>\n\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>Private Room for 2 people (2 beds) shared among friends or family<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_13\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_13'>Let us know if there is somebody specific you want to share your room with:<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_1_13' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_47\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Private transport from Quito\/airport<\/label><div class='gfield_description' id='gfield_description_1_47'>Please check the following fields if you want us to organize private transport for you on the 1st day of the retreat, and\/or the last one. We can pick you up at your hotel in Quito, or at the Mariscal Sucre airport near Quito, or in Tababela (a town close to the airport). Please note that the price may differ according to how many people are requesting transport, but will not exceed $120 USD per person.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_47'><li class='gchoice gchoice_1_47_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.1' type='checkbox'  value='Quito\/aiport -&gt; Feather Crown ($50 USD per person, departure 8-9 AM)'  id='choice_1_47_1'   aria-describedby=\"gfield_description_1_47\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_1' id='label_1_47_1' class='gform-field-label gform-field-label--type-inline'>Quito\/aiport -&gt; Feather Crown ($50 USD per person, departure 8-9 AM)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_47_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.2' type='checkbox'  value='Feather Crown -&gt; Quito\/airport ($50 USD per person, departure 9:00 AM)'  id='choice_1_47_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_2' id='label_1_47_2' class='gform-field-label gform-field-label--type-inline'>Feather Crown -&gt; Quito\/airport ($50 USD per person, departure 9:00 AM)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Work with the plants<\/h2><\/li><li id=\"field_1_21\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_21'>Do you have any previous experience with Ayahuasca? If yes, what were the results?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_1_21' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_22\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>What would you like to achieve and what are your expectations?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_1_22' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_23\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_23'>Referral (first time guests only)<\/label><div class='gfield_description' id='gfield_description_1_23'>How did you hear about Feather Crown? If it was from a website, which one? Thank you for helping us to understand how people find us.<\/div><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_23\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_24'>Message to the organizers:<\/label><div class='gfield_description' id='gfield_description_1_24'>Anything that you want to add:<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_1_24' class='textarea medium'  aria-describedby=\"gfield_description_1_24\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_50\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Make sure we receive your registration:<\/h2><div class='gsection_description' id='gfield_description_1_50'>After you hit the submit button, you should receive an immediate confirmation email. If you don't receive the confirmation email within few minutes, something went wrong with your submission and you need to resend it. Make sure you fill all the obligatory fields, otherwise it won't let you send the form. You can always contact us at info@feathercrown.com if you have any problem.<\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit registration form'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='DtIC9ME8LCaDNmajmwlJF4SmSgDRo2L2dN3hiasBZ9j1HXd\/kb9PMX48GrnF42mO9aL7fE3QSle7dEhFSOV8FLxqwFcfF34BwqUkZvmIUG9tI2E=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_2\" name=\"ak_js\" value=\"174\"\/><script>\ndocument.getElementById( \"ak_js_2\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/feathercrown.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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