Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
Age
*
Education
Occupation
Any ailment or physical limitations?
*
Do you have pain in the body? If yes, please mention.
*
Have you undergone any surgery in recent years?
*
Are you under any medication?
*
Are you practicing yoga or any physical activity?
Aim of joining the class:
How do you know about the class?
Select a Batch
*
Morning - 7:10 to 8:10am
Morning - 10:00 to 11:00am
Evening - 7 to 8:00pm (MWF)
Date of joining:
*
-
Month
-
Day
Year
Date
Submit
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