WORKSHOP REGISTRATION FORM

Please note that all information gathered is strictly confidential, and will be shared only with Intouch Yoga teaching staff as needed.

Name*
First Last
Your Age*
Mobile Phone Number*
Home Phone Number*
Email*
Enter Email Confirm Email
Which Workshop are your applying for?*
Name of Workshop*
Date of Workshop*
Your Occupation
Previous Yoga Experience*
List Medical Conditions and Recent Surgery*
Are you currently on any medication, or taking or withdrawing from any kind of meds/drugs?*
Do you have any history of mental illness?*
What would you most like to get out of the workshop?
Emergency Contact Number*
Join me up for your newsletter
- Yes, join me up!
CAPTCHA

Title