chakra intensive application word - chakra intensive application.docx created date 8/10/2017 8:48:04...
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APPLICATION FOR CHAKRA INTENSIVE TRAINING
ALL INFORMATION ON THIS FORM IS CONFIDENTIAL
BASIC INFORMATION
NAME ________________________________________________________DATE _________________
ADDRESS ______________________________________________CITY _________________________
STATE_________________________ ZIP_________________ COUNTRY_______________________
PHONE: HOME _____________________________ CELL ___________________________________
EMAIL ______________________________________________________________________________
BIRTH DAY _________________BIRTH TIME ____________ LOCATION _____________________
OCCUPATION _______________________________________________________________________
PROGRAM DATES __________________________
_____ I HAVE ENCLOSED PAYMENT OF $850 FOR THE COURSE (please initial)
Credit Card Number: __________________________________ Exp. Date: ____ / ____
or MAKE CHECKS PAYABLE TO: 7 CENTERS YOGA ARTS
PERSONAL INFORMATION 1. How did you hear about 7 Centers Yoga Arts and our program?
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2. What is the main reason for your interest in this program?
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3. List three things you hope to learn/accomplish from our training:
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APPLICATION FOR CHAKRA INTENSIVE 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? _____________________________________________________________________________________________
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5. Please list any physical or mental health conditions that could impact your experience during the training?
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7. Please write a short bio including any other pert inent information here:
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PLEASE RETURN COMPLETED APPLICATION TO: 7 Centers Yoga Arts
2115 Mountain Rd, Sedona, Az 86336 You can email a copy to yoga@7centers.com
Email or Call 928-203-4400 with any Questions
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