Shamanic Creativity Cleanse Individual or Small Group Experience Registration Name* First Last Email* Phone*Please share a little bit about your interest or intention for this cleanse.*Do you have any experience with shamanic ceremony or practice? Please explain.*How would your rate your overall health and wellness at this time? In your response please speak to any significant mental or physical health issues you are currently dealing with.*Name & email of additional participantsIf you are enrolling in a small group cleanse, please enter both name and email for each additional participant you would like to include.PaymentShamanic Creativity Cleanse (Base Price)Price for up to 3 participants Price: Additional Participants Quantity*Please enter the number of additional participants (# of people above the 3 who are included in the base price) you would like to include in your cleanse. Enter 0 for no additional participants. Price: $111.00 Quantity Total $0.00 Coupon Credit Card*Card Details Cardholder Name Consent* I have read and agree to the terms & conditions. Δ
