Email Address

Skype Handle

(please provide Skype handle or a phone number for our interview)

Age

I am interested in

Please pick a retreat or ceremony

City & Country of residence

Please share in a few lines your healing intention or motivation for joining this retreat

Do you have a regular spiritual practice of any kind? (Meditation, yoga, prayer, etc.)

Please select how many times you have used Ayahuasca:

Do you have any physical health issues?

Do you or have you ever suffered from any mental health problems? Please explain

Are you taking any kind of medication? Please explain

Have you had experience with any entheogen or master plant other than Ayahuasca?

Are you interested in extending your stay at Tantraya?

If so, how many nights?

Food allergies and intolerances

How did you hear about Tantraya?

Referral

Did a friend recommend us to you? Help us to thank them

Emergency Contact

Please provide the name and phone number of someone we can contact in case of emergency.

RETREAT APPLICATION