Student Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Birth Date
Month
Day
Year
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Students's Email*
Mobile Number*

Area CodePhone Number
Emergency Contact*

Area CodePhone Number
Do You Have Any Yoga Experience
How Did You Find Us?

Searched on googleSaw our Instagram profileFriend suggested meSaw a google Advt.Saw a FB Advt.I received an email
Courses
Coupon Code (If Any)
Choose Course Start Date
Date
Do you have any food related allergies?
Do you have any medical or health related issue we should know about?
Accommodation*

Triple Shared RoomQuadruple Shared RoomShared RoomPrivate Room
Additional Comments
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Registration Fees
$300

Total

$0.00
Pay with PayPal

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty: