Wirikuta Desert Pilgrimage (Peyote)

PROGRAM REGISTRATION

Thank you for your interest in our program. We are looking forward to welcoming you!
Please follow the registration steps below. After this, you will be invited to an intake call. If you are accepted, we will finalize your booking.

Please note: The $50 registration fee is non-refundable and covers your intake call.
If you are accepted, this will be deducted from the overall donation. If you are taking medication, have a family or personal mental health history, please contact us before continuing your registration.

* These fields are required

1 Welcome

2 Energy Exchange

3 Participant Info

1) Fill out the registration form and make your $50 deposit below.
2) After you have reserved your space, watch for our emails and please book your intake call as soon as possible.
3) Our intake coordinator will confirm your registration.

Please DO NOT book your flights until your registration and intake has been approved.
If for any medical reason a retreat with us is deemed not a good fit, you are entitled to a full refund of any deposit made less the $50 deposit.

What is your date of birth? *	Please note: If you are under 21 years of age at the time of this retreat, we cannot accept your participation.
Phone *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Email newsletter	Please send me the email newsletter
Comments or Special Needs
Gender *	We ask this question for rooming purposes only. If you have questions or concerns about who you may be sharing a room with us, please reach out to support@vaaiga.com
Requested Roommate	Please make sure that all parties request each other.
Diet Notes	Please let us know any dietary requirements or preferences.
Can you say something about the themes and intentions you have for this program? *
How did you hear about us?
Medical Information	It is our job to provide a safe experience for you. To do so, we ask that you please be open about your history and experiences.
Are you currently seeking therapy or treatment by a psychologist, psychiatrist, or other doctor? *	If so, for how long and what is the reason?
Family History *	I confirm that to the best of my knowledge nobody in my family has been diagnosed with schizophrenia or other psychoses, or I have already discussed this with support@ancestralceremonies.org and been cleared.With such powerful medicines, it is important we know of any potential complications to ensure your safety.
Are you currently taking any medications? If so, what? *	Enter "none" if not applicable.
Are you taking any anti depressants? If so, which one? *	Enter "none" if not applicable.
Did you use any medication in the past? If so, what kind of medication and how long for? *	Enter "none" if not applicable.
Do you have problems with your heart, high blood pressure, or any other condition we need to know about to guarantee your safety? *
Non-psychedelic drug usage *	Alcohol Marijuana/THC Cocaine Heroin Other None Please select all that apply.
Prior psychedelic usage *	LSD Psilocybin/Magic Mushrooms DMT/Ayahuasca/Bufo Alvarius Iboga Mescaline/Huachuma/Peyote MDMA Other None
Prior psychedelic experiences *	Tell us a bit about your past experiences if applicable
Emergency Contact	Please provide contact details for someone not traveling with you.
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Email *
Emergency Contact Confirmation	I confirm that my emergency contact is aware of my participation in this program should they need to be contacted.

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4 Policies

Terms and Conditions *	I accept the terms and conditions.Please read the terms and conditions
Registration Fee *	I understand that my $50 initial deposit is non-refundable and covers my intake call.
$100 Membership Fee *	I understand that my $100 membership fee of Institute of Ancestral Ceremonies is included in the overall price of the program and is valid for one year.
Payments do not include the cost of plant medicines. *	I understand that payments made through Retreat Guru do not include the cost of: plant medicine, psychedelics or similar products. There will be no additional charges for this retreat.Supplementary Products Exclusion: Participants acknowledge and agree that these Fees presented and payable pertain solely to Services and Offerings, and will not include the cost of any plant-medicines or similar products (collectively, "Supplementary Products") which may be provided, offered, or distributed by a Commercial User, or any other party, in connection with Services or Offerings. Retreat Guru shall bear no responsibility or liability in connection with any provision, offering, or distribution of Supplementary Products, and is not a party thereto. All capitalized terms used herein shall carry the same meaning as assigned to them in Retreat Guru's Terms of Service.

5 Donation

Discount code

5.4% Credit card fee	$0

Sub Total	$0

Donations	$0

Taxes	$0

Deposit	$0

Due Now	$0 $0

	You will be asked for payment details in the next step. Click the button below to continue.

PROGRAM REGISTRATION

1 Welcome

2 Energy Exchange

Select an option*

Wirikuta pilgrimage spot

3 Participant Info

4 Policies

5 Donation