Yoga for Life
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Yoga for Life
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February 14-21, 2004 Please Print out this application and send with your payment Legal Name _______________________________________ Date of Birth: _________________ Address _____________________________________________________________________ Home Phone: ___________________________ Bus. Phone: _____________________________ Email: ___________________________________ Cell Phone: ___________________________ Employer: ______________________________ Profession: _____________________________ List any Health or Physical Problems: _______________________________________________ ____________________________________________________________________________ Number of years practicing Yoga: ___________________________________________________ How many yoga classes do you attend weekly: _________________________________________ What styles of Yoga do you practice: _________________________________________________ Rooming with ______________________ How did you hear of us: _________________________ Emergency Contact: (Name) __ _________________________ (Phone) _____________________
Garden Room $ (per person double) Ocean View $ (per person double) Beach Front $ (per person double)
Please circle your choices above and include full payment with your Registration Signature: _____________________________ Date: ________________ Mail Registration Form and Payment to: Robert Connell 12 Terry Drive, Suite 201, Newtown, PA 18940 Email: yogaguy@yoga-for-life.org Phone: 215-497-7050
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Copyright © 2006 Yoga for Life
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