Samarya Yoga Therapy Application

We appreciate you taking the time to fill out this application.

The Samarya Yoga Therapy training will take place at the Yoga Shala Portland, Williams Studio, Friday May 30 through Sunday June 1st, 2008.

Please indicate below in the application which training set you are taking.

For more information on the various options, please click here.

Cost:

• IMT Basics ONLY: Friday, May 30, $75/$65 if received by April 30
• IMT and Adults Level 1 ONLY: Saturday and Sunday, May 31-June 1, $350/$300 if received by April 30)
• BOTH IMT Basics & IMT and Adults Level 1: Friday-Sunday, May 30-June 1, $410/$360 if received by April 30)

Once we receive your application, we'll send confirmation and payment info.

Thank you and Namaste.

Name:
Which Classes:	IMT Basics ONLY (Fri) IMT and Adults Level 1 ONLY (Sat/Sun) (If you have already taken IMT Basics, please indicate where) IMT Basics & IMT and Adults Level 1 (Fri-Sun)
Address:
City:
State/Province:
Zip/Postal Code:
Occupation/Place of Employment:
Other Related Professional Experience:
Years Practicing Yoga:
Movement Background (if any):
What Ages of People do You Work With:
What Types of People do You Work With:
What Do You Most Hope to Learn from This Workshop:
How did you hear about this workshop or the Samarya Center:
Add'l Comments:
Phone Number:
Email:
Deposit:	Pre-payments for this training must be received by April 30, no exceptions. Please either: * Send a check to Street Yoga, 833 SE Main St. #226, Portland, OR 97214, or * Directly by PayPal (there will be a PayPal link available when you submit this application).