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Genius Break Away Wait List
Please complete this form so that you'll be the first-to-know about our upcoming Genius Break Away with Dr. Suzie Carmack in December 3-5, 2021 in Miami, Florida
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Full Name
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First Name
Last Name
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Why would you like to take the Yoga for Stress Relief Course in Spring 2022?
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To Commit to My Daily Yoga Pracitice
To Earn Continuing Education
To Join / Re-Join the YogaMedCo Community
All of the Above
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What is your #1 source of stress today?
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Feeling out of balance / pulled into two many directions.
Not enough energy to live the way I would like to.
Not taking care of myself; putting others' needs ahead of my own.
Work Related Stress
Home-based Stress
All of the Above
Other
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E-mail
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Phone Number
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Area Code
Phone Number
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Why are you excited to join this course community?
EX: Jane Doe, 123 Retreat Road, Laketown, PA 16111, janedoe@retreat.com
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