Ayahuasca retreat registration Ayahuasca retreat Registration form Select the event you wish to book:*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. December 2-11, 2024 (10 days) $1590 - Ceremonies led by Don Carlos December 2-6, 2024 (5 days) $790 - Ceremonies led by Don Carlos December 7-11, 2024 (5 days) $790 - Ceremonies led by Don Carlos January 6-15, 2025 (10 days) $1590 - Ceremonies led by Maestro Sina February 3-12, 2025 (10 days) $1590 - Ceremonies led by Maestro Sina February 3-7, 2025 (5 days) $790 - Ceremonies led by Maestro Sina February 8-12, 2025 (5 days) $790 - Ceremonies led by Maestro Sina February 17-26, 2025 (10 days) $1590 - Ceremonies led by Maestro Sina March 17-26, 2025 (10 days) $1590 - Ceremonies led by Maestro Sina Deposit non-refundability akcnowledgement* I am aware that the booking deposit is non-refundable. However any deposit can be transferred 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. Basic informationYour name:* Name Surname E-mail* Enter Email Confirm Email Gender:* Male Female Age:* Residency* City AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Passport number* If you don't have your passport yet, please fill "0" and give us your passport number later.Emergency contact (name, phone number):* Health conditionWhat is your current health condition?*Do you currently suffer from any of the following health conditions? very high blood pressure severe diabetes schizophrenic disorder heart disease or any condition previously diagnosed indicating vulnerability to the heart epilepsy and other seizure related conditions infectious or contagious disease suicidal ideation use of MAO inhibitors or anti-psychotic medication mental illness drug addiction diagnosed terminal illness such as cancer Any medicines or supplements that you are currently using:Allergies: Please list any recreational drugs you are using regularly:* Enter "none" if you are not currently using any recreational drugs.Are you currently pregnant? Yes No 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.Feather Crown Health Screening and Full Disclosure:No supplements, no medications" policy*This retreat involves the ingestion of plants that may be contraindicated with certain medicines or health conditions. All herbal supplements, natural medicines, and medications taken in the period of 30 days before the retreat as well as during the retreat must be disclosed to Feather Crown before the retreat begins. All herbal supplements, natural medicines, and medications (prescription and over-the-counter) cannot be taken during the course of the retreat without the express written permission of Feather Crown. You hereby agree that all information you provide in the application is correct and current and that you have disclosed all physical and psychological conditions as well as all herbal supplements, natural medicines, and medications that you are taking. Check this box if you agree to the Feather Crown Health Screening and Full Disclosure. Feather Crown Medications Note:By checking the box and typing my name in the field below, I attest that I have read and understand all of the above written medical information and have openly disclosed all requested health and medical facts. I attest that the information provided above is true and complete, to the best of my knowledge. I understand that falsifying or omitting any relevant information may be grounds for denying my attendance at the workshop for which I am applying, with or without a refund, at the sole discretion of Feather Crown, I hereby waive, release and hold harmless Feather Crown from any and all liability or responsibility for all injuries and/or damages or claims which may occur in the event I attend. I understand that Feather Crown is not a medical facility and its owners, staff, employees and agents do not practice Western medicine and are not licensed medical doctors.*By checking the box and typing my name in the field below, I attest that I have read and understand all of the above written medical information and have openly disclosed all requested health and medical facts. I attest that the information provided above is true and complete, to the best of my knowledge. I understand that falsifying or omitting any relevant information may be grounds for denying my attendance at the workshop for which I am applying, with or without a refund, at the sole discretion of Feather Crown, I hereby waive, release and hold harmless Feather Crown from any and all liability or responsibility for all injuries and/or damages or claims which may occur in the event I attend. I understand that Feather Crown is not a medical facility and its owners, staff, employees and agents do not practice Western medicine and are not licensed medical doctors. Check this box if you have read and understand the Medications Note Please type your name in CAPITAL letters:* Food, accommodation and transportationPreferred diet:* Normal Vegetarian Vegetarian eating fish Vegan Any special requirements for your diet? Preffered type of accommodation:* Private room for 1 person Private Room for 2 people (2 beds) shared among friends or family Let us know if there is somebody specific you want to share your room with: Private transport from Quito/airportPlease 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. Quito/aiport -> Feather Crown ($50 USD per person, departure 8-9 AM) Feather Crown -> Quito/airport ($50 USD per person, departure 9:00 AM) Work with the plantsDo you have any previous experience with Ayahuasca? If yes, what were the results?*What would you like to achieve and what are your expectations?*Referral (first time guests only)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. Message to the organizers:Anything that you want to add:Make sure we receive your registration: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.
