Retreat Reservation Form

Please only complete this form if you are 100% ready to book your retreat. You should also make sure that you select the right kind of Retreat that best relates to the problems that you need to clear in your life. For example if you have had a lot of drug addictions, or you have consumed a lot of recreational drugs, or if you have negative energies thrown at you, or if you suffer from depression or anxiety - there is little point booking a simple Ceremony retreat. Please contact us if you need help to choose the right retreat. After you complete the form we will contact you to confirm whether your selected dates are still available and send you the complete booking form.

If you would like to contact us before you fill out the pre-booking form for more information about our retreats, please call us on: +44 (0)1225 290 728 and leave a detailed message. You can also make a Skype appointment via our skype name ayamama.healing or email us at: mamaaya@hozhofoundation.com to discuss your needs. We are not always in the country so please be patient and we will get back to you as soon as we can.

Your details:
Fields marked * are compulsory

Full name: *
Email address: *
Phone number: *
Profession: *
Date of Birth: *
Starsign: *

Please select the Retreat you would like to book:

RETREATS THAT INCLUDE 1 CEREMONY
3/4 Days	Ayahuasca & Massage	£550
3/4 Days	Specialist Ayahuasca Healing Ceremony	£550
5 Days	Ayahuasca & 5 Organ Detox	£750
5 Days	Rebirthing & Energy Renewal	£750
5 Days	7 Karma Cleansing	£750
5 Days	Relationship Clearing & Healing	£750
RETREATS THAT INCLUDE 2 CEREMONIES
7/8 Days	7 Karma Cleansing	£1,300
7/8 Days	Depression & Anxiety Clearing	£1,300
7/8 Days	Healing & Clearing Behavioural Problems caused by Sexual Abuse	£1,300
10 Days	Ayahuasca & 5 Organ Detox	£1,300
RETREATS THAT INCLUDE 3 CEREMONIES
10 Days	7 Karma Cleansing	£1,550
10 Days	Depression & Anxiety Clearing	£1,850
10 Days	Healing & Clearing Behavioural Problems caused by Sexual Abuse	£1,850
10 Days	Post Traumatic Stress Healing	£2,100

Please select the date you would like to commence your Retreat:
We advise clients to indicate a second choice of dates in the event that your first choice is no longer available.

1st Choice - week commencing:	-- Select -- 5th March 2012 12th March 2012 19th March 2012 26th March 2012 2nd April 2012 9th April 2012 16th April 2012 23rd April 2012 30th April 2012 7th May 2012 14th May 2012 21st May 2012 28th May 2012 4th June 2012 11th June 2012 18th June 2012 25th June 2012 2nd July 2012 9th July 2012 16th July 2012
2nd Choice - week commencing:	-- Select -- 5th March 2012 12th March 2012 19th March 2012 26th March 2012 2nd April 2012 9th April 2012 16th April 2012 23rd April 2012 30th April 2012 7th May 2012 14th May 2012 21st May 2012 28th May 2012 4th June 2012 11th June 2012 18th June 2012 25th June 2012 2nd July 2012 9th July 2012 16th July 2012

Have you had an Ayahuasca Ceremony before?

-- Select -- Yes No

Are you currently taking any prescription medication?

-- Select -- Yes No

If yes, please state which ones:

How did you hear about us?

-- Select -- Search Engine (Google, Bing! etc) Previous client Newspaper/ Magazine Referring website Word of mouth Other

Please select to be added to our mailing list. Yes