Immersion/Teacher Training Application

Name: *

Address: *

City: *

State: *

Zipcode: *

Home Phone: *

Cell Phone:

Birthdate: *

Emergency Contact Name: *

Emergency Contact Number: *

Email: *

Please specify which sessions you are applying for (Full Training, Immersion I, II, III, Teacher Training I, II, III):

How Did You Hear About Us?:

Marital Status: *

Single

Married

Divorced

High School: *

College: *

Number of Years?: *

Degree?: *

Number of Children?: *

Religious Affiliation (Optional):

How many years have you been practicing yoga & what styles have you practiced?: *

Please list in detail your Anusara yoga experience (classes, training, workshops, etc.): *

Have you attended any previous yoga teacher trainings in other styles of yoga? If so, what year did you attend, what style, school, and location?: *

Current Employer:

Current Employer's Address:

Current Employer's Phone #:

Start Date:

Medical/Spiritual counseling you have experienced - Group: *

Medical/Spiritual counseling you have experienced - Individual: *

Interests and Hobbies: *

What sparked your interest in our program and what are your goals for this training?: *

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