Ananda Seva Yoga of the Heart Certification 2008
Registration Form

Please complete the form below and send it with your deposit for $350 to:
Yoga of the Heart Certification Program, Ananda Seva Mission, P. O. Box 2862, Santa Rosa, CA 95405
Please make checks payable to Ananda Seva Mission.
To pay by VISA, MasterCard, Discover or American Express please call our office.

If you have any questions, please call us at (707) 575-0886 or (707) 703-2553 or email us at: asm@anandaseva.org

Personal Contact Information:

First Name:

Last Name:

Address:

 

Email Address:

Home Phone:                                 

Cell Phone:

Work or Alternative Phone:

Emergency Contact Information:

  Name: Address: Phone Number(s):

Nearest Relative:

 

      

Primary Physician:

 

      

Medical Information:

Allergies:

  

Physical Limitations (injuries, illnesses, any health issue that affects your yoga practice):

  

Special Dietary Needs or Food Allergies:

  

Other Special Needs:

 

  

Accommodation Package: (rates include tuition, instruction, manual and meals):

  Dorm Fee: $1,715.00
  Double Room Fee: $1,865.00
  Private Room Fee: $2,435.00

Enclosed is a check for $350 (Balance is due on arrival.) Deposits are refundable up until one month prior to the start of the first session, less a $100 administrative fee deduction. No credit or refund is available if you do not give proper notice, if you do not show up, or if you leave early. You may pay your deposit or balance by check or credit card (Visa, MasterCard, American Express and Discover Card are accepted). Call our office for paying by credit card.

Isis Oasis is located at 20889 Geyserville Ave, Geyserville, CA 95441. You can fly either to Oakland Airport (OAK) or San Francisco International Airport (SFO) and take the Airport Express (http://www.airportexpressinc.com) to Santa Rosa. They leave from both airports hourly. Bring your own yoga mat, props, belt and blanket. If you like, bring a seat or pillow for meditation and seminars. Please, no smoking, drugs, alcohol, pets, scented body products, incense, candles or other flammables.

Yoga of the Heart Certification 2008
Application Form

Please fill out the application form below, by copying and pasting it into an email. Participants must send in this form to be accepted into the program. If you do not send an application form or your application is not approved for the program, your fees will be refunded.

NOTE: To qualify you must be a certified yoga teacher. Exceptions will be made for medical professionals (nurses, masssage therapists, physicans, etc.) on an individual basis.

Please email your form to the following email address: nd@abundantwellbeing.com

If you have any questions you may email the Abundat Well-Being Center at YOH@abundantwellbeing.com

Personal Contact Information:

Name:

Name you prefer to be called:

Address:

Email Address:

Home Phone:                       
          

Male/Female

Occupation:            

Marital Status:

Date of Birth:

Age:

 

Yoga Background

  1. Where did you receive your yoga teacher certification? 
  2. How long have you been teaching yoga?
  3. Are you currently teaching yoga?
  4. What is your experience with people who are ill? 
  5. Why do you want to work with cardiac patients? 
  6. Do you have a regular spiritual practice of your own?  Please describe. 
  7. How did you hear about Yoga of the Heart?

Please briefly describe your personal and occupational background, as well as the spiritual background that has influenced you to apply to Yoga of the Heart.