Enrollment Form

Your Name (required)

Your Age (required)

Date of birth

Your Email (required)

Skype ID

Have you tried San Pedro and/or Ayahuasca before?

If so, please state which one and how many times

Do you suffer from schizophrenia or have been diagnosed with it in the past?

Do you suffer from epilepsy or have been diagnosed with it in the past?

Do you currently suffer from any other significant physical or psychological conditions?

If so, please state which ones.

Which of the workshops would you like to attend?
The 30 day Good Medicine WayThe 21 day Andean AwakeningThe 14 day Beauty Way

On which dates would you like to come for the workshop?

Please explain the reasons why you would like to sign up for one of our workshops.You can be as thorough and detailed as you like.


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