Registration Form: Los Andes Mountains Chile 2017

 

SHAMANIC JOURNEY TO LOS ANDES SACRED MOUNTAINS

2017: February 13-22

FULL NAME:

ID or PASSPORT NUMBER:

COUNTRY :

ADDRESS :

PHONE :

EMAIL :

ARRIVAL DATE:

RETURN DATE:

 

Airfares are not included

 

JOURNEY’S DATE:

 

AUD 2,200   Shamanic Journey to Los Andes Mountains

AUD 1,870   Early Bird Before: 30 November 2016

AUD 1,870   For MEMBERS of Manos Healing Centre: Before 31 December 2016

 

 

VEGETARIAN      Yes / No

 

FLIGHT DETAILS

ARRIVAL DATE TO SANTIAGO:

AIRLINE:

ARRIVAL TIME:

FLIGHT NUMBER:

 

DEPARTURE DATE FROM SANTIAGO:

AIRLINE:

DEPARTURE TIME:

FLIGHT NUMBER:

 

PAYMENT DETAILS

PAYMENT DATE:

PAYMENT OPTIONS:

CHILE:

Banco Estado
Daniel Blazquez

Cuenta RUT: 7.898.766-9

 

AUSTRALIA:

Commonwealth Bank       

ACCT No: 1074 7882       

BSB: 062-198

MANOS HEALING CENTRE INCORPORATED

AMOUNT DEPOSITED _________________________

 

 

COMMENTS