Registration

Registration
Yoga Teacher Training

APPLICATION FORM
Please print this form and forward it along with your payment to:
Mystis/7Centers, 2115 Mountain Road, Sedona, AZ. 86336

yoga@7centers.com

Name:_________________________________________________________________

Date of Birth:______________________Age:_________Sex:__________

Place of Birth:________________________Time of Birth:____________ (Important this is accurate through a birth certificate if possible)

Marital Status: ____________ Height ________ Weight ___________

Address:_______________________________________________________________

Telephone:_________________________email:________________________________

Credit Card #:_______________________________(visa/mastercard)

ExpDate_______Signature code on the back of your card__________

Signature:______________________________________________________________

_____ Enclosed is a deposit of $500 to reserve my place in the following training:

January/February _______

Apri/Mayl ________

June/July _________

September/October _____

Balance of $2,500 due 30 days prior to 1st date of training.

If you are paying by check please make it payable to Mystis, our non-profit organization.

Please also enclose a photograph of yourself.

Note: A deposit of $500 reserves your place. You may pay by cash, check or by credit card. Once you are accepted for the course, the deposit becomes non-refundable. The full fee is due 30 days before the start of the course and once the course starts, there is no refund. In case of an emergency, you may apply the fee to another course within one year of refund. The fee is not transferrable to another person. The course has a limited number of participants, so please reserve early.

Will you be needing housing arrangements? Yes__ No__
Will you have a car during the month? Yes__ No__
(this is recommended)

I have read, understand & fully accept the tuition refund policy & housing agreement (please sign)________________________

EDUCATION DETAILS

	Major Subjects	Year of Passing	Name of Institution
High School
College or University
Continuing Education
Post Graduate

OCCUPATIONS

______________________________________________________________________________________________________________________

YOGA EXPERIENCE

How long have you been practicing yoga?

______________________________________________________________________________________________________________________

Who have you studied with ? List previous teachers and styles of yoga.

______________________________________________________________________________________________________________________

How has yoga influenced your life?

______________________________________________________________________________________________________________________

Please list any other training or experience that you think is relevant: What would you like to gain from this training?

______________________________________________________________________________________________________________________

What are your goals or intentions in taking this training? ______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Tell us about your physical health (major illnesses, injuries, surgeries, any physical conditions or eating disorders we should know about):
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Have you done any kinds of cleansing or fasting before? Would you consider this valuable to do?
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Please list any prescription or recreational drugs that you are currently using (and for what condition) or have used in the past. This is completely confidential & crucial for us to know in relation to the cleanses. Also, are you a smoker? If you have smoked in the past, how long have you been smoke free? Do you have any body piercings?

Note: It is recommended that you be drug, caffine and alcohol free at least 3 months before the training.
______________________________________________________________________________________________________________________

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List any other interesting things you think you would like us to know:
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Who can we call in case of an emergency:_____________________________

Telephone: ___________________________

How did you hear about us? ________________________________________

Mail to: Mystis/7 Centers Yoga Arts
2115 Mountain Road
Sedona, AZ 86336

7 Centers Yoga Arts does not discriminate on the basis of race, color, or national and ethnic origin in administration of its policies.

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