Registration Form

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First name

Email

Last name

Phone

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Street Address Line 2

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Date Of Birth

Emergency Contact Information

Emergency Contact Name

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Medical and Dietary Information

List Any Medical Conditions

List Any Prior Injuries

List Any Medications

List Any Food Allergies and Restrictions

Ability Information

Hiking

Beginner

Intermediate

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Yoga

Beginner

Intermediate

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Agreements & Policies

I am aware the the trip cost does not include tips for the staff at Willka Tika, bus driver, and tour guides.

Consent for Images to be used for promotional purposes.

I ALLOW photos of me on the trip to be used.

I DO NOT allow photos of me on the trip to be used.

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Peru Retreat Deposit - $1200

Peru Yoga Retreat Deposit - $1200

Northern Peru Treks - $1200

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