In order to register for the Peru retreat, please complete the form below: If you have trouble with this form or have additional questions, you can contact Laura by email at email@example.com or 1-800-611-5144 (toll free in the US and Canada). Peru Registration Form First Name*Last Name*Email Address* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone Number*Cell PhonePaymentDeposit*Single Room Non-Refundable Deposit (Machu Picchu and the Sacred Valley of Peru) - $1,000Double Room Non-Refundable Deposit (Machu Picchu and the Sacred Valley of Peru) - $1,000Single Room Non-Refundable Deposit (Machu Picchu and the Sacred Valley of Peru PLUS Amazon Extension) - $1,200Double Room Non-Refundable Deposit (Machu Picchu and the Sacred Valley of Peru PLUS Amazon Extension) - $1,200Retreat OptionsSingle Room (Machu Picchu and the Sacred Valley of Peru ONLY) - $6,810Double Room (Machu Picchu and the Sacred Valley of Peru ONLY) - $5,825Single Room (Machu Picchu and the Sacred Valley of Peru PLUS Amazon Extension) - $8,200Double Room - (Machu Picchu and the Sacred Valley of Peru PLUS Amazon Extension) - $7,015Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Terms and ConditionsPlease take a moment to access the terms and conditions for this trip. Then return here to complete your registration. The terms and conditions for this trip can be viewed here. (Link will open in a new window/tab).Agreement*I HAVE READ THE TERMS AND CONDITIONS FOR THE WRITE, TRAVEL, TRANSFORM TRIP TO PERU. If this field is not ticked, you won't be able to proceed and complete your registration. Yes, I have read and accept the terms and conditions for this trip. Would you like to be added to Laura's email list?* Yes! Sign me up to get weekly writing prompts from Laura, to receive occasional blog posts, and to stay in touch with future workshops. No. I'd prefer not to be added to the list. Thanks but I'm already on Laura's mailing list! NameThis field is for validation purposes and should be left unchanged.