Program Registration form
First Name *
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Last Name *
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Email *
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Phone *
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City/Country *
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Age: *
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Gender: *
Program: *
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Emergency Contact (name and phone number): *
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Have you learnt any other Isha Yoga practices? YES/NO. If yes, please give details below:
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Do you have any of the following:
Do you have or have had any physical ailments? If yes, please provide details. *
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Do you have or have had any mental or psychological ailments? If yes, please provide details. *
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Are you currently pregnant? *
Have you had any major surgery in the last six months? (If yes, please elaborate) *
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Any additional information:
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How did you get to know about us?
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