BYTA Membership Form
Annual membership to join the Black Yoga Teachers Alliance is $75.00 Your membership will help build a network of professional black yoga teachers throughout the world.
Email address *
Personal Information
Please use your legal name; not the name of your business.
First Name *
Last Name *
Address Line 1 *
Address Line 2
City *
Zip *
Country
Telephone *
Website URL
Emergency Contact Name
Emergency Contact Number
Yoga Training & Certification
If you are applying for membership as certified yoga teacher, please complete the following:
Style/lineage of yoga
Additional styles of yoga not listed
Yoga training school/teacher
Yoga training City
Yoga training State
Yoga Training Zip
Certification Date
MM
/
DD
/
YYYY
Are you a member of Yoga Alliance?
If yes, what is your ID#
What is your certification and registered yoga teacher status:
List any additional yoga teacher memberships
Yoga Teaching Experience
Tell us if you are currently teaching.
How often do you teach?
How many years have you been teaching?
Where do you teach yoga? List state and city/cities where you teach.
List the names of the studio or other locations where you teach below:
Specialized Training
If you have received specialized training or certification(s), please indicate below.
Specialized yoga
If selected other, please list additional specializations here:
Where did you receive your specialized training?
Are you certified in your area of expertise?
Demographics
The Black Yoga Teacher Alliance, Inc. collects demographic data to develop a profile of our membership for the purposes of soliciting donors, grants and sponsors. Your answers in the section are voluntary. Your personal information will not be shared or sold.
Occupation (if not full-time yoga teacher)
Level of education completed:
Marital Status
Household
Number of people living in the home
Annual household income:
Please tell us about yourself and what you seek from membership in the Black Yoga Teachers Alliance. Please include your areas of interest and or expertise in this statement
Pay Membership Fee
You can pay your $75 membership fee here: https://paypal.me/BYTAMember/75
Submit
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