2010 Anusara Yoga Immersion

Application & Registration

First Name
Last Name
Email
Address
City
State
Zip
Home Phone
Mobile Phone
Date of Birth
Website (if applicable)
Occupation
Yoga History & Experience
How long have you been practicing hatha yoga?
How long have you been practicing Anusara Yoga?
What is your level of understanding of Anusara's Unviersal Principles of Alignment?
Please describe your personal practice:
Why do you practice Yoga?
Why do you want to take this particular training?
Please list any and all immersions, workshops, trainings and classes you have participated in with Certified Anusara Teachers.
Event/Training Teacher Location Date Hours
Total Hours:
Do you currently teach yoga?
  yes no
If so, what style and for how many years?
What else do you bring to your training?

Please tell use about any other trainings, healing modalities, retreats and personal work you have engaged in.

Why does wild success at your Immersion/Teacher Training look like for you?
Is there anything else you would like us to know?
Your Health
Please let us know about any injuries, physical conditions, or psychological issues that you feel might get in the way of your full participation. This information is confidential and will help us serve you better.
Are you taking any medications?  yes no
Emergency Contact
Emergency Contact Name
Emergency Contact Phone Number
Payment
Which Immersion/Training are you Applying for? Entire Immersion $1,850.00
Phase 1 $675.00
Phase 2 $675.00
Phase 3 $675.00
Choose method of payment:
Refund Policy
If you register for any part of the Immersion and cancel more than one week before that phase begins, you will receive a refund for the entire amount paid, less a $50 processing fee for each phase that you cancel. No refunds are given if you cancel less than one week before the course begins unless your space can be filled from a waiting list, and the processing fee noted above will be deducted.

By pressing submit, you certify that all information in this application is true and accurate to the best of your knowledge, and you have read, understand, and agree to the above terms and policies.