OGOGOGASHANTAYA YOGA & BODYWORK SCHOOLOPROFESSIONAL TRAINING, PERSONAL TRANSFORMATION, COMMUNITY CONNECTION & MORE


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ANUSARA RETREAT APPLICATION
EARLY 2011 IN CHIANG MAI

Complete all the fields below and submit. You will hear back from us with further details about payment, etc.
In order to secure your retreat space you are required to make a 5,000 THB / € 100 registration deposit.


TITLE:
FIRST NAME:
FAMILY NAME:
NAME I LIKE TO BE CALLED:
HOME ADDRESS:
STATE/PROVINCE:
PHONE:
COUNTRY:
EMAIL:
RETYPE EMAIL:
OCCUPATION:
BIRTH DATES:
A PHOTO OF YOURSELF: (1 MB maximum)
 
   

1) SPECIFY COURSE & DATES:

2) ROOM CHOICE:
ONE WEEK - 1A, 1B, 1C, 1D
TWO WEEKS - 2A, 2B, 2C, 2D


HOW LONG HAVE YOU BEEN PRACTICING YOGA AND WHAT STYLE(S)?
DETAIL YOUR BACKGROUND IN ANUSARA YOGA (IF ANY)?
IF YOU TEACH YOGA, GIVE DETAILS?
MEDICAL CONDITIONS, PHYSICAL LIMITATIONS, INJURIES?
ANYTHING ELSE YOU WOULD LIKE TO SAY OR ASK?
 
HOW DID YOU FIND OUT ABOUT US?
   
Enter Validation Code

 



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2010 | 2011

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