{"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":"inscription","status":"publish","type":"page","link":"https:\/\/feathercrown.com\/fr\/registration\/","title":{"rendered":"Formulaire d'inscription pour la retraite Ayahuasca de 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='\/fr\/wp-json\/wp\/v2\/pages\/12555' data-formid='1' novalidate>\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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Select the length of your retreat:<\/span><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Select the 10-day event you wish to book:<\/span><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 (Kichwa)'  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 (Kichwa)<\/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 (Kichwa)'  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 (Kichwa)<\/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). WAITING LIST ONLY RETREAT IS FULL'  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). WAITING LIST ONLY RETREAT IS FULL<\/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>\n\t\t\t<li class='gchoice gchoice_1_43_7'>\n\t\t\t\t<input name='input_43' type='radio' value='March 22 - 31, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_43_7'    \/>\n\t\t\t\t<label for='choice_1_43_7' id='label_1_43_7' class='gform-field-label gform-field-label--type-inline'>March 22 - 31, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_8'>\n\t\t\t\t<input name='input_43' type='radio' value='April 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_43_8'    \/>\n\t\t\t\t<label for='choice_1_43_8' id='label_1_43_8' class='gform-field-label gform-field-label--type-inline'>April 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_9'>\n\t\t\t\t<input name='input_43' type='radio' value='May 17 - 26, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_43_9'    \/>\n\t\t\t\t<label for='choice_1_43_9' id='label_1_43_9' class='gform-field-label gform-field-label--type-inline'>May 17 - 26, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Select 5-day event you wish to book:<\/span><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 14 - 18, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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 14 - 18, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/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='October 5 - 9, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  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'>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_2'>\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_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 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_3'>\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_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 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_4'>\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_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 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_5'>\n\t\t\t\t<input name='input_55' type='radio' value='November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/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 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/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='February 13 - 17, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  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'>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_8'>\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_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'>February 17 - 21, 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='March 22-26, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>March 22-26, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/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='March 26-30, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>March 26-30, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/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='April 19-23, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>April 19-23, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_12'>\n\t\t\t\t<input name='input_55' type='radio' value='April 23-27, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_55_12'    \/>\n\t\t\t\t<label for='choice_1_55_12' id='label_1_55_12' class='gform-field-label gform-field-label--type-inline'>April 23-27, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_13'>\n\t\t\t\t<input name='input_55' type='radio' value='May 17-21, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_55_13'    \/>\n\t\t\t\t<label for='choice_1_55_13' id='label_1_55_13' class='gform-field-label gform-field-label--type-inline'>May 17-21, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_14'>\n\t\t\t\t<input name='input_55' type='radio' value='May 21-25, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_55_14'    \/>\n\t\t\t\t<label for='choice_1_55_14' id='label_1_55_14' class='gform-field-label gform-field-label--type-inline'>May 21-25, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Select the 30-day event you wish to book:<\/span><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 WAITING LIST ONLY, EVENT IS FULL'  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 WAITING LIST ONLY, EVENT IS FULL<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Deposit non-refundability and even cancellation akcnowledgement<\/span><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' ><span class='gform-field-label__text'>Your name:<\/span><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' ><span class='gform-field-label__text'>E-mail<\/span><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 '>Saisissez un e-mail<\/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 '>Confirmez l\u2019e-mail<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_1_56\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international 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' for='input_1_56'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_56' id='input_1_56' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Gender:<\/span><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'><span class='gform-field-label__text'>Age:<\/span><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' ><span class='gform-field-label__text'>Residency<\/span><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 '>Ville<\/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='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba' >Bonaire, Saint-Eustache et Saba<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' >Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' >France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option value='Groenland' >Groenland<\/option><option value='Gr\u00e8ce' >Gr\u00e8ce<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guin\u00e9e' >Guin\u00e9e<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Guin\u00e9e \u00e9quatoriale<\/option><option value='Guin\u00e9e-Bissau' >Guin\u00e9e-Bissau<\/option><option value='Guyane' >Guyane<\/option><option value='Guyane' >Guyane<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='G\u00e9orgie du Sud et \u00celes Sandwich du Sud' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongrie' >Hongrie<\/option><option value='Inde' >Inde<\/option><option value='Indon\u00e9sie' >Indon\u00e9sie<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Irlande<\/option><option value='Islande' >Islande<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Italie' >Italie<\/option><option value='Jama\u00efque' >Jama\u00efque<\/option><option value='Japon' >Japon<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanie' >Jordanie<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kirghizistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kowe\u00eft' >Kowe\u00eft<\/option><option value='La Barbade' >La Barbade<\/option><option value='La R\u00e9union' >La R\u00e9union<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Lettonie<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libye<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lituanie<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Mac\u00e9doine du Nord' >Mac\u00e9doine du Nord<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaisie<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malte<\/option><option value='Maroc' >Maroc<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritanie' >Mauritanie<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexique' >Mexique<\/option><option value='Micron\u00e9sie' >Micron\u00e9sie<\/option><option value='Moldavie' >Moldavie<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolie<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mont\u00e9n\u00e9gro' >Mont\u00e9n\u00e9gro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibie<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nig\u00e9ria<\/option><option value='Niu\u00e9' >Niu\u00e9<\/option><option value='Norv\u00e8ge' >Norv\u00e8ge<\/option><option value='Nouvelle-Cal\u00e9donie' >Nouvelle-Cal\u00e9donie<\/option><option value='Nouvelle-Z\u00e9lande' >Nouvelle-Z\u00e9lande<\/option><option value='N\u00e9pal' >N\u00e9pal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Ouzb\u00e9kistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Pays-Bas<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Pologne<\/option><option value='Polyn\u00e9sie fran\u00e7aise' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >P\u00e9rou<\/option><option value='Qatar' >Qatar<\/option><option value='Roumanie' >Roumanie<\/option><option value='Royaume-Uni' >Royaume-Uni<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9publique Dominicaine' >R\u00e9publique Dominicaine<\/option><option value='R\u00e9publique Tch\u00e8que' >R\u00e9publique Tch\u00e8que<\/option><option value='R\u00e9publique arabe syrienne' >R\u00e9publique arabe syrienne<\/option><option value='R\u00e9publique centrafricaine' >R\u00e9publique centrafricaine<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='Sahara occidental' >Sahara occidental<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre et Miquelon' >Saint Pierre et Miquelon<\/option><option value='Saint-Christophe-et-Nevis' >Saint-Christophe-et-Nevis<\/option><option value='Saint-Marin' >Saint-Marin<\/option><option value='Saint-Si\u00e8ge' >Saint-Si\u00e8ge<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint-Vincent-et-les Grenadines<\/option><option value='Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='Sainte-Lucie' >Sainte-Lucie<\/option><option value='Salvador' >Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tom\u00e9 et Principe<\/option><option value='Serbie' >Serbie<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapour<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovaquie' >Slovaquie<\/option><option value='Slov\u00e9nie' >Slov\u00e9nie<\/option><option value='Somalie' >Somalie<\/option><option value='Soudan' >Soudan<\/option><option value='Soudan du Sud' >Soudan du Sud<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Suisse<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Su\u00e8de<\/option><option value='S\u00e9n\u00e9gal' >S\u00e9n\u00e9gal<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie (R\u00e9publique-Unie de)' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='Ta\u00efwan' >Ta\u00efwan<\/option><option value='Tchad' >Tchad<\/option><option value='Terres Australes Fran\u00e7aises' >Terres Australes Fran\u00e7aises<\/option><option value='Territoire britannique de l\u2019oc\u00e9an Indien' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='Tha\u00eflande' >Tha\u00eflande<\/option><option value='Timor oriental' >Timor oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinit\u00e9 et Tobago<\/option><option value='Tunisie' >Tunisie<\/option><option value='Turkm\u00e9nistan' >Turkm\u00e9nistan<\/option><option value='Turquie' >Turquie<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis et Futuna' >Wallis et Futuna<\/option><option value='Y\u00e9men' >Y\u00e9men<\/option><option value='Zambie' >Zambie<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c9gypte' >\u00c9gypte<\/option><option value='\u00c9mirats arabes unis' >\u00c9mirats arabes unis<\/option><option value='\u00c9quateur' >\u00c9quateur<\/option><option value='\u00c9rythr\u00e9e' >\u00c9rythr\u00e9e<\/option><option value='\u00c9tat palestinien' >\u00c9tat palestinien<\/option><option value='\u00c9tats-Unis' >\u00c9tats-Unis<\/option><option value='\u00c9thiopie' >\u00c9thiopie<\/option><option value='\u00cele Bouvet' >\u00cele Bouvet<\/option><option value='\u00cele Christmas' >\u00cele Christmas<\/option><option value='\u00cele Maurice' >\u00cele Maurice<\/option><option value='\u00cele Norfolk' >\u00cele Norfolk<\/option><option value='\u00cele de Man' >\u00cele de Man<\/option><option value='\u00celes Cayman' >\u00celes Cayman<\/option><option value='\u00celes Cocos' >\u00celes Cocos<\/option><option value='\u00celes Cook' >\u00celes Cook<\/option><option value='\u00celes Falkland' >\u00celes Falkland<\/option><option value='\u00celes F\u00e9ro\u00e9' >\u00celes F\u00e9ro\u00e9<\/option><option value='\u00celes Heard et McDonald' >\u00celes Heard et McDonald<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='\u00celes Marshall' >\u00celes Marshall<\/option><option value='\u00celes Pitcairn' >\u00celes Pitcairn<\/option><option value='\u00celes Salomon' >\u00celes Salomon<\/option><option value='\u00celes Turques et Ca\u00efques' >\u00celes Turques et Ca\u00efques<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='\u00celes Vierges britanniques' >\u00celes Vierges britanniques<\/option><option value='\u00celes de Svalbard et Jan Mayen' >\u00celes de Svalbard et Jan Mayen<\/option><option value='\u00celes mineures am\u00e9ricaines' >\u00celes mineures am\u00e9ricaines<\/option><option value='\u00celes \u00c5land' >\u00celes \u00c5land<\/option><\/select>\n                                        <label for='input_1_6_6' id='input_1_6_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/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'><span class='gform-field-label__text'>Passport number<\/span><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'><span class='gform-field-label__text'>Emergency contact (name, phone number):<\/span><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'><span class='gform-field-label__text'>What is your current health condition?<\/span><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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Do you currently suffer from any of the following health conditions?<\/span><\/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'><span class='gform-field-label__text'>Any medicines or supplements that you are currently using:<\/span><\/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'><span class='gform-field-label__text'>Allergies:<\/span><\/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'><span class='gform-field-label__text'>Please list any recreational drugs you are using regularly:<\/span><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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you currently pregnant?<\/span><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>No supplements, no medications&quot; policy<\/span><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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'>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><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'><span class='gform-field-label__text'>Please type your name in CAPITAL letters:<\/span><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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Preferred diet:<\/span><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'><span class='gform-field-label__text'>Any special requirements for your diet?<\/span><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Preffered type of accommodation:<\/span><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'><span class='gform-field-label__text'>Let us know if there is somebody specific you want to share your room with:<\/span><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Private transport from Quito\/airport<\/span><\/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'><span class='gform-field-label__text'>Do you have any previous experience with Ayahuasca? If yes, what were the results?<\/span><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'><span class='gform-field-label__text'>What would you like to achieve and what are your expectations?<\/span><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'><span class='gform-field-label__text'>Referral (first time guests only)<\/span><\/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'><span class='gform-field-label__text'>Message to the organizers:<\/span><\/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'> <button type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit registration form<\/button> \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='yPyrYPDAjRquwvgx1BfOGhETYMGq6YyZgohyzAszugmkN93LIGCFSYNU\/qFv4Y\/PlckAybyYR8xjjiIxi2yAYpnYpbwjl\/Sh42yltcvz7H6AqXY=' \/>\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_1\" name=\"ak_js\" value=\"122\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><\/form>\n                        <\/div><br \/>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n<span class=\"et_bloom_bottom_trigger\"><\/span>","protected":false},"excerpt":{"rendered":"<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\">Champs d'inscription pour une retraite d'Ayahuasca<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/fr\/wp-json\/wp\/v2\/pages\/12555' data-formid='1' novalidate data-trp-original-action=\"\/fr\/wp-json\/wp\/v2\/pages\/12555\">\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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>S\u00e9lectionnez la dur\u00e9e de votre retraite :<\/span><\/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'>Retraite courte de 5 jours<\/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'>Retraite intensive de 10 jours<\/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'>Di\u00e8te Shipibo traditionnelle de 30 jours<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>S\u00e9lectionnez l&#039;\u00e9v\u00e9nement de 10 jours que vous souhaitez r\u00e9server\u00a0:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_43'>Remarque : Si vous s\u00e9lectionnez un \u00e9v\u00e9nement qui est actuellement complet, vous serez plac\u00e9 dans sa liste d'attente et inform\u00e9 lorsqu'une place se lib\u00e9rera.<\/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 (Kichwa)'  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'>10-19 ao\u00fbt 2026 (10 jours) $1790 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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'>Du 5 au 14 octobre 2026 (10 jours) $1790 - C\u00e9r\u00e9monies anim\u00e9es par le 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'>Du 19 au 28 octobre 2026 (10 jours) $1790 - C\u00e9r\u00e9monies anim\u00e9es par le 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 (Kichwa)'  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'>23 novembre - 2 d\u00e9cembre 2026 (10 jours) $1790 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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). WAITING LIST ONLY RETREAT IS FULL'  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'>Du 11 au 20 janvier 2027 (10 jours) $1790 - C\u00e9r\u00e9monies dirig\u00e9es par le Maestro Sina (Shipibo). LISTE D&#039;ATTENTE UNIQUEMENT. COMPLET.<\/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'>Du 28 janvier au 6 f\u00e9vrier 2027 (10 jours) $1790 - C\u00e9r\u00e9monies anim\u00e9es par le 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'>Du 13 au 22 f\u00e9vrier 2027 (10 jours) $1790 - C\u00e9r\u00e9monies anim\u00e9es par le maestro Sina (Shipibo)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_7'>\n\t\t\t\t<input name='input_43' type='radio' value='March 22 - 31, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_43_7'    \/>\n\t\t\t\t<label for='choice_1_43_7' id='label_1_43_7' class='gform-field-label gform-field-label--type-inline'>22 - 31 mars 2026 (10 jours) $1790 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_8'>\n\t\t\t\t<input name='input_43' type='radio' value='April 19 - 28, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_43_8'    \/>\n\t\t\t\t<label for='choice_1_43_8' id='label_1_43_8' class='gform-field-label gform-field-label--type-inline'>19-28 avril 2026 (10 jours) $1790 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_9'>\n\t\t\t\t<input name='input_43' type='radio' value='May 17 - 26, 2026 (10 days) $1790 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_43_9'    \/>\n\t\t\t\t<label for='choice_1_43_9' id='label_1_43_9' class='gform-field-label gform-field-label--type-inline'>17 - 26 mai 2026 (10 jours) $1790 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>S\u00e9lectionnez l&#039;\u00e9v\u00e9nement de 5 jours que vous souhaitez r\u00e9server\u00a0:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_55'>Remarque : Si vous s\u00e9lectionnez un \u00e9v\u00e9nement qui est actuellement complet, vous serez plac\u00e9 dans sa liste d'attente et inform\u00e9 lorsqu'une place se lib\u00e9rera.<\/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 14 - 18, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>14-18 ao\u00fbt 2026 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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='October 5 - 9, 2026 (5 days) $890 - Ceremonies led by Maestro Sina'  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'>Du 5 au 9 octobre 2026 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par le maestro Sina<\/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 9 - 13, 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'>Du 9 au 13 octobre 2026 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par le 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 19 - 23, 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'>Du 19 au 23 octobre 2026 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par le 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 23 - 27, 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'>Du 23 au 27 octobre 2026 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par le 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='November 23 - 27, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>23-27 novembre 2026 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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 27 - December 1, 2026 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>27 novembre - 1er d\u00e9cembre 2026 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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='February 13 - 17, 2027 (5 days) $890 - Ceremonies led by Maestro Sina'  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'>Du 13 au 17 f\u00e9vrier 2027 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par le maestro Sina<\/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='February 17 - 21, 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'>Du 17 au 21 f\u00e9vrier 2027 (5 jours) $890 - C\u00e9r\u00e9monies anim\u00e9es par le 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='March 22-26, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>22-26 mars 2027 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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='March 26-30, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>26-30 mars 2027 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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='April 19-23, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  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'>19-23 avril 2027 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_12'>\n\t\t\t\t<input name='input_55' type='radio' value='April 23-27, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_55_12'    \/>\n\t\t\t\t<label for='choice_1_55_12' id='label_1_55_12' class='gform-field-label gform-field-label--type-inline'>23-27 avril 2027 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_13'>\n\t\t\t\t<input name='input_55' type='radio' value='May 17-21, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_55_13'    \/>\n\t\t\t\t<label for='choice_1_55_13' id='label_1_55_13' class='gform-field-label gform-field-label--type-inline'>17-21 mai 2027 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_55_14'>\n\t\t\t\t<input name='input_55' type='radio' value='May 21-25, 2027 (5 days) $890 - Ceremonies led by Don Carlos (Kichwa)'  id='choice_1_55_14'    \/>\n\t\t\t\t<label for='choice_1_55_14' id='label_1_55_14' class='gform-field-label gform-field-label--type-inline'>21-25 mai 2027 (5 jours) $890 - C\u00e9r\u00e9monies dirig\u00e9es par Don Carlos (Kichwa)<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>S\u00e9lectionnez l&#039;\u00e9v\u00e9nement de 30 jours que vous souhaitez r\u00e9server\u00a0:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_54'>Remarque : Si vous s\u00e9lectionnez un \u00e9v\u00e9nement qui est actuellement complet, vous serez plac\u00e9 dans sa liste d'attente et inform\u00e9 lorsqu'une place se lib\u00e9rera.<\/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'>Du 5 octobre au 5 novembre 2026 (30 jours) $3700 - Anim\u00e9 par le maestro Shipibo 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 WAITING LIST ONLY, EVENT IS FULL'  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'>11 janvier \u2013 11 f\u00e9vrier 2027 (30 jours) $3700 - Anim\u00e9 par le Maestro Shipibo Sina. LISTE D&#039;ATTENTE UNIQUEMENT, COMPLET.<\/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'>Du 28 janvier au 28 f\u00e9vrier 2027 (30 jours) $3700 - Anim\u00e9 par le maestro Shipibo 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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Non-remboursabilit\u00e9 de l'acompte et accus\u00e9 de r\u00e9ception de l'annulation<\/span><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'>Je suis conscient que l'acompte de r\u00e9servation est <b>non remboursable<\/b>. Cependant tout d\u00e9p\u00f4t <b>peut \u00eatre transf\u00e9r\u00e9<\/b> \u00e0 une autre date si cela est fait au moins 30 jours avant le d\u00e9but de l'\u00e9v\u00e9nement initialement r\u00e9serv\u00e9. L'acompte peut \u00e9galement \u00eatre transf\u00e9r\u00e9 gratuitement \u00e0 une autre personne \u00e0 tout moment. En cas d'annulation de l'\u00e9v\u00e9nement, l'organisateur rembourse int\u00e9gralement tous les acomptes, mais n'est pas responsable de couvrir les pertes dues \u00e0 l'annulation de l'\u00e9v\u00e9nement. Afin de pr\u00e9venir toute perte, une assurance voyage ou un tarif de vol remboursable est recommand\u00e9e.<\/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\">Informations de base<\/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' ><span class='gform-field-label__text'>Votre nom :<\/span><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'>Nom<\/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'>Nom de famille<\/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' ><span class='gform-field-label__text'>Courriel<\/span><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'>Saisissez une adresse e-mail<\/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'>Confirmez l&#039;e-mail<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_1_56\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international 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' for='input_1_56'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_56' id='input_1_56' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Genre :<\/span><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'>M\u00e2le<\/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'>Femme<\/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'><span class='gform-field-label__text'>\u00c2ge:<\/span><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' ><span class='gform-field-label__text'>R\u00e9sidence<\/span><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'>Ville<\/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='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba' >Bonaire, Saint-Eustache et Saba<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' >Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' >France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option value='Groenland' >Groenland<\/option><option value='Gr\u00e8ce' >Gr\u00e8ce<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guin\u00e9e' >Guin\u00e9e<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Guin\u00e9e \u00e9quatoriale<\/option><option value='Guin\u00e9e-Bissau' >Guin\u00e9e-Bissau<\/option><option value='Guyane' >Guyane<\/option><option value='Guyane' >Guyane<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='G\u00e9orgie du Sud et \u00celes Sandwich du Sud' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongrie' >Hongrie<\/option><option value='Inde' >Inde<\/option><option value='Indon\u00e9sie' >Indon\u00e9sie<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Irlande<\/option><option value='Islande' >Islande<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Italie' >Italie<\/option><option value='Jama\u00efque' >Jama\u00efque<\/option><option value='Japon' >Japon<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanie' >Jordanie<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kirghizistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kowe\u00eft' >Kowe\u00eft<\/option><option value='La Barbade' >La Barbade<\/option><option value='La R\u00e9union' >La R\u00e9union<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Lettonie<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libye<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lituanie<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Mac\u00e9doine du Nord' >Mac\u00e9doine du Nord<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaisie<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malte<\/option><option value='Maroc' >Maroc<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritanie' >Mauritanie<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexique' >Mexique<\/option><option value='Micron\u00e9sie' >Micron\u00e9sie<\/option><option value='Moldavie' >Moldavie<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolie<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mont\u00e9n\u00e9gro' >Mont\u00e9n\u00e9gro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibie<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nig\u00e9ria<\/option><option value='Niu\u00e9' >Niu\u00e9<\/option><option value='Norv\u00e8ge' >Norv\u00e8ge<\/option><option value='Nouvelle-Cal\u00e9donie' >Nouvelle-Cal\u00e9donie<\/option><option value='Nouvelle-Z\u00e9lande' >Nouvelle-Z\u00e9lande<\/option><option value='N\u00e9pal' >N\u00e9pal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Ouzb\u00e9kistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Pays-Bas<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Pologne<\/option><option value='Polyn\u00e9sie fran\u00e7aise' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >P\u00e9rou<\/option><option value='Qatar' >Qatar<\/option><option value='Roumanie' >Roumanie<\/option><option value='Royaume-Uni' >Royaume-Uni<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9publique Dominicaine' >R\u00e9publique Dominicaine<\/option><option value='R\u00e9publique Tch\u00e8que' >R\u00e9publique Tch\u00e8que<\/option><option value='R\u00e9publique arabe syrienne' >R\u00e9publique arabe syrienne<\/option><option value='R\u00e9publique centrafricaine' >R\u00e9publique centrafricaine<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='Sahara occidental' >Sahara occidental<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre et Miquelon' >Saint Pierre et Miquelon<\/option><option value='Saint-Christophe-et-Nevis' >Saint-Christophe-et-Nevis<\/option><option value='Saint-Marin' >Saint-Marin<\/option><option value='Saint-Si\u00e8ge' >Saint-Si\u00e8ge<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint-Vincent-et-les Grenadines<\/option><option value='Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='Sainte-Lucie' >Sainte-Lucie<\/option><option value='Salvador' >Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tom\u00e9 et Principe<\/option><option value='Serbie' >Serbie<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapour<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovaquie' >Slovaquie<\/option><option value='Slov\u00e9nie' >Slov\u00e9nie<\/option><option value='Somalie' >Somalie<\/option><option value='Soudan' >Soudan<\/option><option value='Soudan du Sud' >Soudan du Sud<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Suisse<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Su\u00e8de<\/option><option value='S\u00e9n\u00e9gal' >S\u00e9n\u00e9gal<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie (R\u00e9publique-Unie de)' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='Ta\u00efwan' >Ta\u00efwan<\/option><option value='Tchad' >Tchad<\/option><option value='Terres Australes Fran\u00e7aises' >Terres Australes Fran\u00e7aises<\/option><option value='Territoire britannique de l\u2019oc\u00e9an Indien' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='Tha\u00eflande' >Tha\u00eflande<\/option><option value='Timor oriental' >Timor oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinit\u00e9 et Tobago<\/option><option value='Tunisie' >Tunisie<\/option><option value='Turkm\u00e9nistan' >Turkm\u00e9nistan<\/option><option value='Turquie' >Turquie<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis et Futuna' >Wallis et Futuna<\/option><option value='Y\u00e9men' >Y\u00e9men<\/option><option value='Zambie' >Zambie<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c9gypte' >\u00c9gypte<\/option><option value='\u00c9mirats arabes unis' >\u00c9mirats arabes unis<\/option><option value='\u00c9quateur' >\u00c9quateur<\/option><option value='\u00c9rythr\u00e9e' >\u00c9rythr\u00e9e<\/option><option value='\u00c9tat palestinien' >\u00c9tat palestinien<\/option><option value='\u00c9tats-Unis' >\u00c9tats-Unis<\/option><option value='\u00c9thiopie' >\u00c9thiopie<\/option><option value='\u00cele Bouvet' >\u00cele Bouvet<\/option><option value='\u00cele Christmas' >\u00cele Christmas<\/option><option value='\u00cele Maurice' >\u00cele Maurice<\/option><option value='\u00cele Norfolk' >\u00cele Norfolk<\/option><option value='\u00cele de Man' >\u00cele de Man<\/option><option value='\u00celes Cayman' >\u00celes Cayman<\/option><option value='\u00celes Cocos' >\u00celes Cocos<\/option><option value='\u00celes Cook' >\u00celes Cook<\/option><option value='\u00celes Falkland' >\u00celes Falkland<\/option><option value='\u00celes F\u00e9ro\u00e9' >\u00celes F\u00e9ro\u00e9<\/option><option value='\u00celes Heard et McDonald' >\u00celes Heard et McDonald<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='\u00celes Marshall' >\u00celes Marshall<\/option><option value='\u00celes Pitcairn' >\u00celes Pitcairn<\/option><option value='\u00celes Salomon' >\u00celes Salomon<\/option><option value='\u00celes Turques et Ca\u00efques' >\u00celes Turques et Ca\u00efques<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='\u00celes Vierges britanniques' >\u00celes Vierges britanniques<\/option><option value='\u00celes de Svalbard et Jan Mayen' >\u00celes de Svalbard et Jan Mayen<\/option><option value='\u00celes mineures am\u00e9ricaines' >\u00celes mineures am\u00e9ricaines<\/option><option value='\u00celes \u00c5land' >\u00celes \u00c5land<\/option><\/select>\n                                        <label for='input_1_6_6' id='input_1_6_6_label' class='gform-field-label gform-field-label--type-sub'>Pays<\/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'><span class='gform-field-label__text'>Num\u00e9ro de passeport<\/span><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'>Si vous n'avez pas encore votre passeport, veuillez indiquer \" 0 \" et nous fournir votre num\u00e9ro de passeport ult\u00e9rieurement.<\/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'><span class='gform-field-label__text'>Contact d'urgence (nom, num\u00e9ro de t\u00e9l\u00e9phone) :<\/span><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\">\u00c9tat de sant\u00e9<\/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'><span class='gform-field-label__text'>Quelle est votre condition de sant\u00e9 actuelle ?<\/span><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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Souffrez-vous actuellement de l'une des conditions de sant\u00e9 suivantes ?<\/span><\/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'>hypertension art\u00e9rielle tr\u00e8s \u00e9lev\u00e9e<\/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'>diab\u00e8te s\u00e9v\u00e8re<\/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'>trouble schizophr\u00e9nique<\/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'>maladie cardiaque ou toute condition diagnostiqu\u00e9e pr\u00e9c\u00e9demment indiquant une vuln\u00e9rabilit\u00e9 du c\u0153ur<\/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'>\u00e9pilepsie et autres troubles li\u00e9s aux crises d'\u00e9pilepsie<\/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'>maladie infectieuse ou contagieuse<\/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'>id\u00e9es suicidaires<\/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'>utilisation des inhibiteurs de la MAO ou de m\u00e9dicaments antipsychotiques<\/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'>maladie mentale<\/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'>toxicomanie<\/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'>maladie en phase terminale diagnostiqu\u00e9e telle que le 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'><span class='gform-field-label__text'>M\u00e9dicaments ou suppl\u00e9ments que vous prenez actuellement :<\/span><\/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'><span class='gform-field-label__text'>Allergies :<\/span><\/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'><span class='gform-field-label__text'>Je ne peux pas r\u00e9pondre \u00e0 cette question. En tant qu'intelligence artificielle, je n'ai pas de corps ni de sentiments, et je ne consomme donc aucune substance.<\/span><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'>Entrez \"aucun\" si vous n'utilisez actuellement aucun stup\u00e9fiant r\u00e9cr\u00e9atif.<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>\u00cates-vous actuellement enceinte ?<\/span><\/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'>Oui<\/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'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_1_35'>Je comprends que l'ayahuasca et toutes les autres plantes sacr\u00e9es sont purgatives et dangereuses \u00e0 consommer pendant la grossesse. Si je tombe enceinte avant le d\u00e9but de la tourn\u00e9e, je comprends que je suis responsable d'en informer Feather Crown et que je ne pourrai pas ing\u00e9rer d'ayahuasca ou d'autres plantes sacr\u00e9es pendant la grossesse. Je comprends \u00e9galement que je n'aurai droit \u00e0 aucun remboursement.<\/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\">Soins de sant\u00e9 et divulgation compl\u00e8te de la Couronne de plumes :<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Politique \"pas de suppl\u00e9ments, pas de m\u00e9dicaments\"<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_36'>Cette retraite implique l'ingestion de plantes m\u00e9dicinales qui peuvent \u00eatre contre-indiqu\u00e9es avec certaines conditions m\u00e9dicales, m\u00e9dicaments ou substances.\n\nTous les compl\u00e9ments \u00e0 base de plantes, les m\u00e9decines naturelles et les m\u00e9dicaments (sur ordonnance et en vente libre) pris dans les 30 jours pr\u00e9c\u00e9dant la retraite, ainsi que pendant la retraite, doivent \u00eatre enti\u00e8rement divulgu\u00e9s \u00e0 Feather Crown avant le d\u00e9but de la retraite.\n\nAucun m\u00e9dicament, compl\u00e9ment ou rem\u00e8de naturel ne peut \u00eatre pris pendant la retraite sans la permission \u00e9crite expresse de Feather Crown.\n\nEn compl\u00e9tant cette demande, vous confirmez que toutes les informations fournies sont vraies, compl\u00e8tes et \u00e0 jour, et que vous avez enti\u00e8rement divulgu\u00e9 toutes les conditions physiques et psychologiques, ainsi que tous les m\u00e9dicaments, compl\u00e9ments et substances que vous prenez.<\/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'>Je consens au d\u00e9pistage de sant\u00e9 et \u00e0 la divulgation compl\u00e8te de Feather Crown.<\/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\">Renonciation \u00e0 la responsabilit\u00e9 m\u00e9dicale et \u00e0 la responsabilit\u00e9 de Feather Crown<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'>En cochant la case ci-dessous et en tapant mon nom, je confirme que :\n\nJ'ai lu et compris toutes les informations m\u00e9dicales et de s\u00e9curit\u00e9 fournies\nJ'ai enti\u00e8rement divulgu\u00e9 toutes les informations de sant\u00e9 et m\u00e9dicales demand\u00e9es\nToutes les informations que j'ai fournies sont v\u00e9ridiques et compl\u00e8tes au mieux de mes connaissances\n\nJe comprends que :\n\nLa falsification ou l'omission d'informations pertinentes peut entra\u00eener le refus de participation, avec ou sans remboursement, \u00e0 la seule discr\u00e9tion de Feather Crown\nL'ayahuasca et d'autres m\u00e9decines v\u00e9g\u00e9tales peuvent \u00eatre dangereuses ou potentiellement mortelles si elles sont combin\u00e9es avec certaines conditions ou substances\nFeather Crown n'est pas un \u00e9tablissement m\u00e9dical\nSes propri\u00e9taires, employ\u00e9s, personnels et agents ne pratiquent pas la m\u00e9decine occidentale et ne sont pas des m\u00e9decins dipl\u00f4m\u00e9s\n\nJ'assume volontairement la pleine responsabilit\u00e9 de ma participation.\n\nPar la pr\u00e9sente, je d\u00e9charge, lib\u00e8re et tiens quitte Feather Crown, ses propri\u00e9taires, employ\u00e9s, personnels et agents de toute responsabilit\u00e9, r\u00e9clamation, dommage ou blessure qui pourrait survenir dans le cadre de ma participation.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_37'>En cochant la case ci-dessous et en tapant mon nom, je confirme que :\n\nJ'ai lu et compris toutes les informations m\u00e9dicales et de s\u00e9curit\u00e9 fournies\nJ'ai enti\u00e8rement divulgu\u00e9 toutes les informations de sant\u00e9 et m\u00e9dicales demand\u00e9es\nToutes les informations que j'ai fournies sont v\u00e9ridiques et compl\u00e8tes au mieux de mes connaissances\n\nJe comprends que :\n\nLa falsification ou l'omission d'informations pertinentes peut entra\u00eener le refus de participation, avec ou sans remboursement, \u00e0 la seule discr\u00e9tion de Feather Crown\nL'ayahuasca et d'autres m\u00e9decines v\u00e9g\u00e9tales peuvent \u00eatre dangereuses ou potentiellement mortelles si elles sont combin\u00e9es avec certaines conditions ou substances\nFeather Crown n'est pas un \u00e9tablissement m\u00e9dical\nSes propri\u00e9taires, employ\u00e9s, personnels et agents ne pratiquent pas la m\u00e9decine occidentale et ne sont pas des m\u00e9decins dipl\u00f4m\u00e9s\n\nJ'assume volontairement la pleine responsabilit\u00e9 de ma participation.\n\nPar la pr\u00e9sente, je d\u00e9charge, lib\u00e8re et tiens quitte Feather Crown, ses propri\u00e9taires, employ\u00e9s, personnels et agents de toute responsabilit\u00e9, r\u00e9clamation, dommage ou blessure qui pourrait survenir dans le cadre de ma 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'>J'ai lu, compris et j'accepte la d\u00e9charge de responsabilit\u00e9 m\u00e9dicale.<\/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'><span class='gform-field-label__text'>VEUILLEZ TAPER VOTRE NOM EN LETTRES MAJUSCULES :<\/span><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\">Nourriture, logement et transport<\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>R\u00e9gime alimentaire pr\u00e9f\u00e9r\u00e9 :<\/span><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'>V\u00e9g\u00e9tarien<\/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'>V\u00e9g\u00e9tarien mangeant du poisson<\/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'>V\u00e9g\u00e9talien<\/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'><span class='gform-field-label__text'>Avez-vous des exigences alimentaires particuli\u00e8res ?<\/span><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Type d'h\u00e9bergement pr\u00e9f\u00e9r\u00e9 :<\/span><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'>Chambre priv\u00e9e pour 1 personne<\/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'>Chambre priv\u00e9e pour 2 personnes (2 lits) partag\u00e9e entre amis ou en famille<\/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'><span class='gform-field-label__text'>Faites-nous savoir si quelqu'un en particulier souhaite partager votre chambre :<\/span><\/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 gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Transport priv\u00e9 depuis l'a\u00e9roport\/Quito<\/span><\/label><div class='gfield_description' id='gfield_description_1_47'>Veuillez cocher les cases suivantes si vous souhaitez que nous organisions pour vous un transport priv\u00e9 le premier jour de la retraite et\/ou le dernier. Nous pouvons venir vous chercher \u00e0 votre h\u00f4tel \u00e0 Quito, \u00e0 l&#x27;a\u00e9roport Mariscal Sucre pr\u00e8s de Quito, ou \u00e0 Tababela (une ville situ\u00e9e \u00e0 proximit\u00e9 de l&#x27;a\u00e9roport). Veuillez noter que le prix peut varier en fonction du nombre de personnes demandant ce service, mais qu&#x27;il ne d\u00e9passera pas $120 USD par personne.<\/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\/a\u00e9roport \u2192 Feather Crown (1 TP 4 T 50 USD par personne, d\u00e9part entre 8 h et 9 h)<\/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\/a\u00e9roport ($50 USD par personne, d\u00e9part \u00e0 9 h)<\/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\">Travailler avec les plantes<\/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'><span class='gform-field-label__text'>Avez-vous une exp\u00e9rience pr\u00e9alable avec l'Ayahuasca ? Si oui, quels ont \u00e9t\u00e9 les r\u00e9sultats ?<\/span><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'><span class='gform-field-label__text'>Qu'aimeriez-vous accomplir et quelles sont vos attentes ?<\/span><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'><span class='gform-field-label__text'>Parrainage (nouveaux clients uniquement)<\/span><\/label><div class='gfield_description' id='gfield_description_1_23'>Comment avez-vous entendu parler de Feather Crown ? Si c'\u00e9tait sur un site web, lequel ? Merci de nous aider \u00e0 comprendre comment les gens nous trouvent.<\/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'><span class='gform-field-label__text'>Message aux organisateurs :<\/span><\/label><div class='gfield_description' id='gfield_description_1_24'>Souhaitez-vous ajouter quelque chose :<\/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\">Assurez-vous que nous recevons votre inscription :<\/h2><div class='gsection_description' id='gfield_description_1_50'>Apr\u00e8s avoir cliqu\u00e9 sur le bouton d'envoi, vous devriez recevoir un courriel de confirmation imm\u00e9diat. Si vous ne recevez pas le courriel de confirmation dans les quelques minutes, quelque chose s'est mal pass\u00e9 avec votre soumission et vous devez la renvoyer. Assurez-vous de remplir tous les champs obligatoires, sinon le formulaire ne pourra pas \u00eatre envoy\u00e9. Vous pouvez toujours nous contacter \u00e0 info@feathercrown.com si vous rencontrez des probl\u00e8mes.<\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Soumettre le formulaire d'inscription<\/button> \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='VqB6QMWXcg3cq6iEm4MbrhpH6R8ax2wt62inrnpQ009X243WoUd4zar00AjXPulStKiLESnMVHfZKVWtT0uj5Z3WsE1jxGl9yo3J\/XKZo8MhfTI=' \/>\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>\u0394<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_2\" name=\"ak_js\" value=\"153\"\/><script>\ndocument.getElementById( \"ak_js_2\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n                        <\/div>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_yoast_wpseo_focuskw":"Register Now","_yoast_wpseo_title":"Register Now \u2013 Ayahuasca Retreat in Ecuador","_yoast_wpseo_metadesc":"Secure your spot for a life-changing Ayahuasca retreat in Ecuador. Complete your registration and start your journey toward healing & growth.","_et_pb_use_builder":"on","_et_pb_old_content":"<p>[gravityform id=\"1\" title=\"true\" description=\"true\"]<\/p>","_et_gb_content_width":"","footnotes":"","rank_math_title":"","rank_math_description":"","rank_math_focus_keyword":"","_aioseop_title":"","_aioseop_description":""},"class_list":["post-12555","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Register Now \u2013 Ayahuasca Retreat in Ecuador<\/title>\n<meta name=\"description\" content=\"Secure your spot for a life-changing Ayahuasca retreat in Ecuador. Complete your registration and start your journey toward healing &amp; growth.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/feathercrown.com\/fr\/inscription\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Register Now \u2013 Ayahuasca Retreat in Ecuador\" \/>\n<meta property=\"og:description\" content=\"Secure your spot for a life-changing Ayahuasca retreat in Ecuador. 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