200-hr Yoga Teacher Training Program Online Registration - Innerpeace Yoga Therapy

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200-hr Yoga Teacher Training Program Online Registration

Online Registration Form Yoga Teacher Training Program

Student Registration and Application Yoga Teacher Training Program A $500.00 deposit is due with your completed application. A balance of $2200 is due if paid in full by Dec 31, 2018. Or a balance of $2400 if paid in 3 installment of $800 in Feb, March & April.

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Today's Date*
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Name
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Enter Email Confirm Email
Referred by
How did you learn about Inner Peace Yoga Therapy Yoga Teacher Training program? (check all that apply)*
- I practice at YogaDurango
- Internet Search
- My yoga teacher recommended it (please list teacher's name below)
- My friend told me about it
Teacher's name recommending this program
More About You
How many years have you been practicing yoga?
How many days per week to you practice yoga?
What style of yoga do you usually practice?
Where do you currently practice?
Do you have a home practice?
- Yes
- No
Who have been your primary yoga teachers?
Do you practice meditation or Pranayama?
Is this your first teacher training or in-depth study?
- Yes
- No
If no, please list prior trainings:
Are you currently teaching yoga?
- Yes
- No
If yes, for how many years have you been teaching?
Where do you teach?
What style do you teach?
Why are you interested in this Yoga Teacher Training program?
What are your expectations for this training? What do you hope to achieve at the completion of the program?

Medical History
Please complete the medical history section below so that we can be sure to respond to any emergencies should they occur during your training. Please note that none of your responses will exclude your from being accepted into the program.
How would you evaluate your current health?
- Excellent
- Good
- Fair
- Some challennges
(please describe)
Do you suffer from any of the conditions below?
- Epilepsy
- Diabetes
- High Blood Pressure
- No, I do not suffer from the above conditions to the best of my knowledge
Explain any past or present physical injuries that sometimes require yoga modifcations
How is your current level of stress?
Are you pregnant or do you plan to become pregnant during the course of training?
- Yes
- No
Are you currently or during the last two years have you been under the care of a physician or mental health care professional?
Please list medications you are taking prescribed by your physician or mental health care professional.
Payment Information
Deposit*
Price:
Total
$0.00
(Your application will be reviewed within 30 days. A $500 deposit is due with your application in order to secure your space in the training. Full payment is required no later than the start of the program unless other arrangements have been made between the student and Inner Peace Yoga Therapy. Inner Peace Yoga Therapy accepts cash, check, PayPal, Amex, Visa, MasterCard and Discover.) To register via email or mail, download this application and: Mail to: Inner Peace Yoga Therapy, PMB #411, 10 Town Plaza Durango CO 81301 USA or email: info@innerpeaceyogatherapy.com

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inner peaceyoga therapy

970.946.8961
info@innerpeaceyogatherapy.com
10 Town Plaza, PMB #411, Durango CO 81301 USA

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