Registration for July 4th Yoga Retreat- The Art of Simple Living, 07/02/10

First Name: Last Name:

Spiritual Name: (if you have not been given a spiritual name, leave blank)

Age: DOB: Sex: Male Marital Status:

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Email: Day Phone: Evening Phone:

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Medical and Emergency Information

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Emergency Contact: Relationship:

Emergency Contact Email: Emergency Contact Phone:

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Have you visited the Yoga Farm before? YesNo

How did you learn about the Yoga Farm?

Please describe your experience with yoga and meditiation:

The Sivananda Ashram Yoga Farm is a 501(c)(3) volunteer-based non-profit organization (530) 272-9322/(800)469-9642 - 14651 Ballantree, Grass Valley, CA 95949 - yogafarm@sivananda.org
Website design and programming by Rob Hecker