Apply | Selva Madre

APPLICATION

THIS APPLICATION WILL NOT CONFIRM YOUR BOOKING BUT WILL START THE PROCESS
or you may email us below

Your Name

Preferred Pronoun

Code

Phone

Nationality

Date of Birth

Length of Visit

Date of Arrival

Date of Departure

Introduction

Diet

Medical History

Medications

Addictions

Intention

Questions

Emergency Contact

Please read all sections of What To Expect and acknowledge

I have read all sections of What To Expect, including the Safety page. I understand that I will need to pay a $500 US deposit in order to make a reservation. I also understand that this deposit is nonrefundable if I cancel my trip for any reason. Deposits may be credited to trips that are rescheduled.

Please note: Deposits can be done through PayPal. PayPal will charge a fee of $22.45 when a payment is marked as "Goods and Services" rather than "Friends and Family". If you choose to mark your payment as "Goods and Services", please change your deposit to $522.45.

APPLICATION

THIS APPLICATION WILL NOT CONFIRM YOUR BOOKING BUT WILL START THE PROCESS or you may email us below

THIS APPLICATION WILL NOT CONFIRM YOUR BOOKING BUT WILL START THE PROCESS
or you may email us below