APPLICATION FOR KUNDALINI TANTRA INTRO COURSE ALL INFORMATION ON THIS FORM IS CONFIDENTIAL BASIC INFORMATION NAME _______________________________________________________________ DATE _________________ ADDRESS __________________________________________________________________ ZIP _____________ PHONE: HOME _________________________________ CELL _______________________________________ EMAIL _________________________________________________ FAX ________________________________ BIRTHDAY _____________________ EXACT TIME _______________ LOCATION _____________________ OCCUPATION _________________________________ PERSONAL INFORMATION 1. How did you hear about 7 Centers Yoga Arts and our program? _____________________________________________________________________________________________ 2. What is the main reason for your interest in this program? _____________________________________________________________________________________________ 3. List 3 Things you hope to learn/accomplish from our training: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. What is your experience with Yoga? How long have you been practicing, where and with whom? What are the most rewarding and challenging aspects of your practice? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. Please list any physical or mental health conditions that could impact your experience during the intensive? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6. Please provide two personal references (Name, Phone Number, Email): _____________________________________________________________________________________________ _____________________________________________________________________________________________ 7. Please write a short bio on the back of this form.

Kundalini Tantra Intro Application - 7 Centers Yoga Arts · PDF file · 2014-11-21Title: Microsoft Word - Kundalini Tantra Intro Author: Middle Office Created Date: 11/21/2014 10:18:19

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Page 1: Kundalini Tantra Intro Application - 7 Centers Yoga Arts · PDF file · 2014-11-21Title: Microsoft Word - Kundalini Tantra Intro Author: Middle Office Created Date: 11/21/2014 10:18:19

APPLICATION FOR KUNDALINI TANTRA INTRO COURSE

ALL INFORMATION ON THIS FORM IS CONFIDENTIAL

BASIC INFORMATION NAME _______________________________________________________________ DATE _________________ ADDRESS __________________________________________________________________ ZIP _____________ PHONE: HOME _________________________________ CELL _______________________________________ EMAIL _________________________________________________ FAX ________________________________ BIRTHDAY _____________________ EXACT TIME _______________ LOCATION _____________________ OCCUPATION _________________________________ PERSONAL INFORMATION 1. How did you hear about 7 Centers Yoga Arts and our program? _____________________________________________________________________________________________ 2. What is the main reason for your interest in this program? _____________________________________________________________________________________________ 3. List 3 Things you hope to learn/accomplish from our training: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. What is your experience with Yoga? How long have you been practicing, where and with whom? What are the most rewarding and challenging aspects of your practice? _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. Please list any physical or mental health conditions that could impact your experience during the intensive? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6. Please provide two personal references (Name, Phone Number, Email): _____________________________________________________________________________________________ _____________________________________________________________________________________________ 7. Please write a short bio on the back of this form.