EmailMe Form - Styles Yoga 300hr Advanced Teacher Training

Which module are you applying for? *
Upper Extremity
Lower Extremity
Spine
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Advance
Teach
How did you hear about our program?
Name
First Last
Phone
### - ### - ####
Email
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Gender
Female
Male
Birthday
MM / DD / YYYY
Occupation
Emergency Contact
(Name & Phone Number)
Yoga Experience
Please list your previous yoga training experience.
Physical Health & Conditions
Tell us about your physical health. Do you have any current or past injuries, major illnesses, or physical limitation or conditions?
Are you currently taking any medications?
Yes
No
If yes, please list any current medications
Additional Information
Is there anything else you would like to tell us about yourself? Please include any training dates you will not be able to attend.
Tuition & Deposit Agreement
I agree
I agree to pay the total cost of the tuition at $765.00.

A deposit of $300.00 will secure your space in the training.

All deposits and payments are nonrefundable but may be put towards a future module.
Signature
I agree
I am the individual given above. I confirm that all information provided herein is true, accurate and up to date. Further, I agree that to the extent that there are any changes to the information provided above that may affect my ability to attend the Teacher Training, I shall inform Styles Yoga as soon as possible hereof. I understand and agree that any and all information I submit via this Online Application Form will be sent to The Hot Yoga Spot, Styles Yoga and myself for the purposes of registration and application for the training in question. In addition, I confirm that I have read, understood and agreed to the payment and refund terms.