SHANTAYA YOGA & BODYWORK SCHOOL
INSPIRED TEACHINGS & EFFECTIVE THERAPEUTIC TOOLS TO ENJOY & SAVOR THE FULLNESS OF MODERN LIVING


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2012 CHIANG MAI ANUSARA RETREAT APPLICATION

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 place a 5,000 THB/week registration deposit is required.


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)
 
   
WHICH RETREAT ARE YOU APPLYING FOR?

COURSE,
DATES & ROOM CHOICE:


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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