Andean Permaculture Immersion PDC Application
Full Name *
Email Address *
Phone Number *
Skype address (if applicable) *
Facebook page (URL link) *
Passport Number *
Country of citizenship *
Birth Date *
Gender *
How did you find out about this retreat? *
Please let us know if you heard from a specific friend, Facebook, website, email, or other.
Describe your motivation for participating in this retreat. *
How would you like to bring the lessons, skills, and teachings you learn in this retreat back to your life and community? *
Do you have any previous experience with permaculture or natural building? *
Which accommodation package do you want? *
Would you like to join for the optional 10-day weaving/herbology add-on ? (keeping same accommodations as marked above) *
Check all that apply for your diet diet *
List any food allergies or intolerances and describe their severity *
Describe any physical conditions, diseases, or any health concerns. *
List any medications you are taking, particularly pharmaceuticals (including vaccines). *
Describe any mobility issues or physical constraints that we should know about *
Describe any mental illness, psychological conditions, or acute difficulties. *
Share any other comments, information or special instructions for us. *
I agree that my 30% deposit, which is required upon my acceptance letter, is non-refundable to hold my position in the retreat. (if for some reason the minimum occupancy does not fill on our end, we will of course return your deposit in full) *
When bringing the remaining tuition in cash to Peru-- I commit to bring fresh bills with no tiny rips. *
This is good to remember for all cash you bring for your journey--- you will be unable to exchange ripped cash (even if it is the slightest bit). Take the time to get freshies!
I hereby give Reviveolution permission to use my photographic likeness in images taken during this retreat on their website and in print material for the use in promotion of their projects and program *
Emergency contact info *
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