Home Forms Form - Travel Adventures
Form - Travel Adventures Print E-mail
Forms

REGISTRATION FORM


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 Name 
Email Address 
Name:
Address:
City:
State:
Zip:
Country:
Phone:
Date of Birth:
Time of Birth:
Place of Birth:
Passport number
Country of Passport Issue
Emergency Contact Person
Emergency Contact Phone
Existing Medical Condition (y/n) Yes    No
Are you taking Medications (y/n) Yes    No
If Yes to either, Detail (in case of emergency)

My electronic signature, below, is a legal signature:

Signed:
 
Date:   

Submit form, then Send payment from Purchase Page.



 < Enter Verification Code

 

After Registering by Submitting the above form you will be directed to the Purchase Page to send your Online Payment or Deposit using PayPal or a Major Credit Card. 

You may also register and pay via the postal service using our 
Print and Mail Option 

Deposits are non-refundable.
 
If for any reason Jade Wah'oo Grigori should cancel a Shamanic Event or Class all deposits and payments will be returned in full.

Last Updated on Monday, 16 February 2009 06:21
 
 
jade-corn_sm_round.png

Future Travel Poll

Travel Poll