Yoga Nidra Module Application
Thank you for your interest in the Yoga Nidra courses! Please complete the items below to help us best serve you:
Email address *
Name (as you'd like it on your certificate) *
Your answer
Date of Birth *
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Occupation *
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Mailing Address *
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Contact Phone Number *
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What is your experience with Yoga Nidra? *
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Are you a Cle Yoga Teacher's Kula Member?
For which module(s) are you applying? *
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How will you attend your module(s)? *
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Which options are you adding?
Do you have any physical or psychological health concerns? If yes, please describe. *
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Are you taking any medications for the above concerns or other conditions? If yes, please list. *
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What is your intention for taking this training? *
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Please provide a reference with contact email and/or phone numbers. *
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How did you hear about this training? *
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I assert that I have answered the above questions accurately and completely. I understand that all of my responses will be kept confidential, and my information will never be shared or sold with a third party without my explicit consent; that once this form is submitted, I will receive a link to pay for my chosen option(s) via PayPal invoice to Dharma Kshetra Yoga, LLC; and that all payments made are NON-REFUNDABLE. *
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We are excited that you have chosen this program to deepen your knowledge of Yoga Nidra and share its benefits to others. Namaste!
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A copy of your responses will be emailed to the address you provided.
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