Name * First Name Last Name Email * What is the best phone number to reach you at? * Have you completed a 200hr yoga teacher training? * Yes No If you answered no to the questions above please provide a brief summary of your qualifications and interest in this program. Do you work primarily with groups or one-on-one? * Groups One on one Both Briefly describe your experience with yoga, meditation/mindfulness and breath work * No experience is needed. This information is strictly so I can direct the training and pre-work according to experience. Are you currently suffering from untreated acute emotional distress? * Yes No If you answered yes to the question above please tell me a little more about what is going on for you (all answers will remain confidential) Is there anything you would like me to know about yourself or your clients before the immersion begins? Will you be a paying deposit, in-full or do you want a payment plan * Deposit ($100) In-full ($497 before 12/18 or $597 after) Payment plan (3 payments of $230) Payment type * What is your preferred payment type. If you pay by credit card there will be a 5% administration fee added to the cost of the course. Credit Card E-transfer Do you identify as a person with limited financial resources and would like to be considered for a subsidy? If you answer yes I will be in touch to discuss options. Subsidies are offered on a sliding scale based on household income and self-determined access to resources. Yes No Thank you! I will be in touch shortly with registration details.
