Thank you for applying for an ayahuasca retreat at the Vancouver Island Ayahuasca Center! To begin our registration process, please fill out this form, and we will try to get back to you within 24 hours with any follow up questions we may have.

All information provided will be kept private and confidential.

Please be sure to have read our Ayahuasca Safety page.

For your own safety and well being, it is important the medical background and medication information be truthful and accurate. Certain conditions and medications have potentially serious risks when combined with ayahuasca.