Curandero Seminar Reservation Form

AMAZON CURANDERO SEMINAR RESERVATION FORM
Fill out the reservation form now to secure your spot for the Curandero Seminar
Then confirm your reservation by mailing your deposit of $375 to the address below or
PAY WITH A CREDIT CARD RIGHT NOW BY CLICKING THE PAY NOW BUTTON BELOW!

Your Name...............................................
Your Email Address..................................
Country...................................................
Date of Birth.............................................
Dietary Restrictions...................................
Travelling Companions (you may list 2).......
List any medication you are currently taking
How did you find out about the Seminar?
Questions or Comments............................


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A Deposit of $375 is Required to Confirm Your Reservation. Deposits are due by March 5, 2008

Please send a check or money order to:

AYAHUAYRA
21 Davis Rd.
Millbury, MA 01527
USA

USE A CREDIT CARD TO CONFIRM NOW!

Using Internet Explorer? Click here to make your payment.

RESERVE YOUR SPACE - BOOK YOUR FLIGHTS - CONFIRM YOUR REGISTRATION
After you pay the deposit, the remainder of the payment shall be given at registration upon arrival in Iquitos, Peru