Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Can you commit yourself to full participation in this program? *

Yes

No

I recognize the commitment required to enter into the Yoga Synthesis™ Advanced Teacher Training. If accepted into the program, I agree and understand that Certification is based on full and complete participation and attendance at all training sessions. *

I agree