El Mundo Magico Journeys: Booking and Information Form

El Mundo Magico

Magical Journeys to Peru

Booking Form

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Programme
* Programme Required

Preferred Departure Date (dd/mm/yy)

Alternative Departure Date (dd/mm/yy)

Travel Details

Include flight number, carrier name, date and time of arrival for applicable flight details.

International Flight details / arrival in Lima:

National Flight details / arrival in Iquitos (if known/applicable):

International flight details / departure from Lima:

National flight details / departure from Iquitos (if known/applicable):

Number of Travellers:

Personal Details
Title:

* First Name:

Middle Name:

* Family Name:

* Age:

* Address:

* City:

* Postal/zipcode:

* State:

* Country:

* Daytime Phone:

Evening Phone:

Mobile Phone:

Fax:

* Email:

Alternative Email:

* Vegetarian:

* Date of Birth (dd/mm/yyyy)

* Place of Birth

* Nationality

* Passport Number

* Country of Issue

* Issue Date

* Date of Expiry

* Contact in case of emergency:

Other

* Interpreter Spanish-English required ?:

(Please note that the interpreter is compulsory if you don't speak Spanish, for the ayahuasca/plant diet retreat in Ashi Meraya)

Yes
No

Where did you hear about us? Please tick all that applies:

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El Mundo Magico, Flat 5, 8 Queen's Road, Lexden, Colchester CO3 3NP, Essex, United Kingdom -

Tel/Fax: + 44-(0) 1206 710 615 - Email: El Mundo Magico (info@elmundomagico.org) -

Web: www.ayahuasca-shamanism.co.uk

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