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  Shamanic Travel Adventures Registration

 

REGISTRATION FORM:
To register your intention to participate in the Shamanic Travel Adventure, please fill all fields then click the SUBMIT button.
I choose to participate in the following Shamanic Travel Adventure:
Adventure 
Email Address 
Name:
Address:
City:
State:
Zip:
Country:
Phone:
Date of Birth:
Time of Birth:
Place of Birth:
Passport #
Country of Passport Issue
Emergency Contact Person
Emergency Contact Phone #
Existing Medical Condition (y/n) Yes    No
Are you taking any Medications Yes    No
If Yes to either, Detail (in case of emergency)
A deposit of $1,000 deposit is due upon Registration. Payment must be made with a Cashier's Check (sorry, no personal checks), made out and sent to:

Jade Wah'oo Grigori
PO Box 4448
Sedona, Az 86340 USA

No other form of payment will be accepted for Shamanic Travel Adventures.

The $1,000 deposit is non-refundable. 

If Jade Wah'oo Grigori should for any reason cancel a Shamanic Travel Adventure all deposits and payments will be returned in full.

My electronic signature, below, is a legal signature:

Signed:
Date:  

Submit form, then send payment.


 

For any other questions contact Jade at:

928-284-0110
JadeWahoo@Shamanic.net

 

 

 

 

 

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For further information or for correspondence, please email Jade Wah'oo Grigori:

© 2000-2007 JadeWahoo@Shamanic.net