Peru Sacred Journey with the Shamans: Personal Application

Please complete the following Personal Application so that we may ensure your ability to participate.

Peru Sacred Journey with the Shamans

Personal Application
Name*

First NameLast Name
Email*
example@example.com
Cell Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Tell us about yourself:*
Why do you want to embark on this journey?*
Peru is a high altitude destination with many uneven surfaces. What is your level of fitness?*

Fit (Workout 4-6 times a week)Moderately fit (Workout 1-2 times a week)Sedentary (No cardio/ workout less than once a week)Recovering from an injury that prevents me from exercisingOther
Please tell us more about your injury and recovery process*
What is your age range?*

20-3536-5051-6050-65Over 65
What is your daily personal energy level?*

LowModerateHigh
Do you have a history of any injuries to your knees, feet, legs or back?*

YesNo
Please explain:*
Peru does not have a wide variety of specialty foods. Please explain your diet and what you need to eat to feel energized? *
Is your diet:*

StrictModerately FlexibleEasy Going
Can you eat primarily vegetarian meals for 8 days?*

YesNo
Are you willing to purchase trip insurance?*

YesNo
Anything else you want us to know about you…
Thank you for your answers
Should be Empty: