* Name
* Street Address
Address line 2
* City
* State
* Postal / Zip Code
* Email Address
* Phone Number
* Occupation
* Birth Date(mm/dd/yyyy)
* Emergency Contact Name & Phone Number
* How did you hear about our program?
* Describe your yoga practice.
* What interests you in the Connecticut power Yoga Live Your Power Program?
* What does Yoga mean to you?
* What do you hope to gain/learn from this program? What are your expectations?
* Please explain your willingness to be fulling committed to the program.
* Tell us about your hobbies, interests, other exercise practices, community service, etc.
Anything else you would like us to know about you?
* How would you evaluate your current health? Are you currently or have you during the last two years been under the care of a physician or health care professional? If yes, please explain.
I understand that my $500 deposit is non refundable upon acceptance into the program and that tuition is due prior to start date. Tuition is non-refundable once the program commences. I agree to the terms and conditions of the TLDP Agreement (Terms are subject to change).
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