Date of Yin Yoga + Sound Bath Class

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email Address

Mobile Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name & Phone Number

Your Yoga Experience/Level & Any Relevant Injuries or Physical Restrictions

Please specify if you take any prescribed medication or if you have any medical condition that may effect your ability to practice yoga.

How did you hear about us?

Your place is not reserved until you have paid for your place in class. All payments are non-refundable.

Please transfer payment to the following account:
Natwest Bank
Account Number 88984044
Sort Code 60-17-21