conflict resolution registration form

7 Centers Yoga Arts Conflict Resolution Registration Form

Please print this form and forward it along with your payment to:

7 Centers Yoga Arts, 2115 Mountain Road, Sedona, AZ. 86336 or email to: yoga@7centers.com

Name: _______________________________________________________

Date of Birth: _______________________ Sex: _______

Street Address, State & Zip Code: ______________________________________________________________________________________

Telephone: _____________________________ Email: _________________________________

*We will be sending you an orientation letter - let us know if you need it mailed to a particular address. Otherwise we will contact you by e-mail.

Credit Card #: (Visa/Mastercard) : _______________________________ Exp. Date: ____________

Signature code on the back of your card__________

( ) Enclosed is the full amount of $600.00

( ) If prior to January 17th, 2012 - Early Registration in full is $500.00.

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

What do you hope to gain from this workshop?

___________________________________________________________________________________________________________________

Is there anything you would like for us to know about your health or personal history?

___________________________________________________________________________________________________________________

Is this part of completing your 500 hour certification with 7 Centers? _________

Will you need assistance with housing?________ Will you have a car while you are here? ________