Shanmukhi Mudra Registration Form
Isha Hatha Yoga - Shanmukhi Mudra

Saturday, January 25th 2020 - 12:30PM – 01:30PM

Location:
2065 Dundas St. E, Unit 103
Mississauga, L4X 2W1

Age: 14+

Program Fee: $80
Early Bird Fee: $60 (until 20 Jan 2020)
Treedollar discount: $10 (inquire within for details)

Contact:
Summit Lalwani
647-524-4553
therootsofyoga@gmail.com
www.therootsofyoga.com
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Please provide details of yoga or meditation you have practices and how long you have been practicing.
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Have you learnt any other Isha Yoga practices? Yes/No. If Yes, please give details
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Please indicate below if you currently or previously have had any physical or mental ailments:
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I hereby willingly undertake to attend this program completely. I take full responsibility for the result and indemnify the organizers against all claims and suits. I will not communicate the contents of the program, either directly or indirectly to anyone else. I understand the participation guidelines and agree to follow them. I hereby declare that the above information is true, accurate and complete to the best of my knowledge. (Electronic signature of your Full Name & Date is required in space below) *
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A copy of your responses will be emailed to the address you provided.
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