SAMYOGA Registration Form
Address: Roof Top Middle Cliff Beach, Varkala, TRIVANDRUM, KERALA
Contact us at +91 82815 50650 or samyoga.enquiry@gmail.com
Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Sex M/F *
Nationality *
Your answer
Occupation *
Your answer
Address *
Your answer
Tel.No with Code *
Your answer
Email *
Your answer
Any exercise/ yoga/ other practices *
Your answer
Habits if any, smoking/drinking/any other *
Your answer
Are you undergoing any Medical Concerns/Issues? *
Your answer
Do you have any special need during this program? *
Your answer
Are you a qualified yoga teacher, if yes, Please specify the Institution Name *
Your answer
After successful registration, the yoga teacher will email the registration fee details via mail ( no refund).
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