APPLICATION FORM
Please print this form and forward it along
with your payment to:
Mystis/7Centers, 2115
Mountain Road, Sedona, AZ. 86336
Name:_______________________________________________________
Date of Birth:______________________Age:_________Sex:__________
Place of Birth:________________________
Time of Birth:____________ (VERY IMPORTANT - from 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 $750 to reserve my place in the following training:
January/February _______
June/July _________
September/October _____
Balance of $2,545 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 $750 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.
Upon receipt of your registration and deposit, you will receive a packet of information with more
detail about when to be here, how to get here, what to bring, housing suggestions, etc. Along with
that information, you will be sent some advance reading materal to be done prior to the start
of the training.
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
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YOGA EXPERIENCE
How long have you been practicing yoga?
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Who have you studied with ? List previous teachers and styles of yoga.
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How has yoga influenced your life?
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Please list any other training or experience that you think is relevant:
What would you like to gain from this training?
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What are your goals or intentions in taking this training?
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Tell us about your physical health (major illnesses, injuries, surgeries, any
physical conditions or eating disorders we should know about):
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Have you done any kinds of cleansing or fasting before?
Would you consider
this valuable to do?
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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:
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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