Niroga Yoga Teacher Training programs

Certified Yoga Teacher Training Program Application
Fall 2010 - Spring 2011

We appreciate your interest in the Niroga Yoga Teacher Training Program. Please complete the following information and click submit to file your application.

Application Information - bold fields are required
Name:
Street Address:
City:
State:
Zip Code
Primary Phone:
Home Phone:
Work Phone:
Cell Phone:
Email:
Occupation:
Date of Birth
Sex:
How did you hear about this program?

Emergency Contacts:
Name: Phone:
Name: Phone:
Physician: Phone:

Experience:
How long have you practiced yoga?
Describe your personal practice of yoga and how regularly you practice:
What styles/traditions of yoga have you practiced?
What style/tradition do you practice now?
Have you taken any yoga training programs or courses?
Are you currently teaching yoga?
How often do you teach yoga?
What styles of yoga do you teach?
How long have you been teaching?
Have you studied yoga philosophy?

Motivation:
Why do you want to take this training program?
What are your goals and objectives for this course?
Do you have any special interests or capabilities that may be relevant?

Health Information:
Current health:
Pregnant / How long:
Chronic physical limitation/disability:	Details:
Prescription medications and/or natural remedies (include condition)	Details:
Serious illness or major surgery in the last 5 years:	Details:
Communicable Diseases:	Details:
Current psychotherapy, counseling, or psychiatric treatment for Drug/alcohol addiction or Eating Disorder?	Details:

Payment Total Cost - $3000.00 Fees include all classes, instruction, books, and materials. Payment Plan ~ $500.00 non refundable reservation due with acceptance of application ~ $2500.00 due at start of module 1 Refund Policy ~ The $500.00 reservation fee is non-refundable. ~ The $2500.00 fee is fully refundable up to 5 days before the start of training. ~ Within 5 days of the start of training, there are no refunds. Disclosure and Acceptance of Terms By submitting this form I hereby declare the above information is true to the best of my knowledge. I understand that misrepresentation of this information constitutes grounds for the rejection of this application, expulsion from the program and revocation of certification. In the event of rejection, expulsion, or revocation of certification, I understand that I am entitled to no refunds, credits, or adjustments.

Niroga Yoga Teacher Training programs

Certified Yoga Teacher Training Program Application Fall 2010 - Spring 2011

Experience:

Motivation:

Health Information:

Payment

Certified Yoga Teacher Training Program Application
Fall 2010 - Spring 2011