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| We must report all program participants to the National Reserve and they request this information. |
| Name and phone number |
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| Special considerations or anything else you'd like to mention regarding your diet |
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| If you want to provide more detailed information |
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| If you want to provide more detailed information |
| Write "healthy" if you have no issues |
| Pharmaceutical, natural, vitamins, supplements, etc. |
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| Ayahuasca, DMT, mushrooms, LSD, san pedro, peyote, mescaline, ecstasy, etc. |
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| yoga, meditation, qi gong, martial arts, sun gazing, etc. |
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| What instrument(s)? For how long? |
| NOTE: Singing healing songs (icaros) is central to this tradition |
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| Please provide the name of the person who will share a room with you, or just answer 'no' |
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| click to read the Terms and Conditions |
| Type the letters and numbers you see above to verify that you are actually a person. |