PLEASE FILL OUT THIS FORM AS COMPLETELY AS POSSIBLE TO HELP US
SERVE YOUR NEEDS.  E-MAIL US IF YOU HAVE QUESTIONS:
   
      mail@mandhirayoga.com

Please note that registering does not guarantee you a space in a course.  If the
course fills up before you register, you will be able to choose a later session or
get a full refund.  You will receive an e-mail confirmation when your space is
set.  Thank you.

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*Which date and location?

  Please contact us by phone or email to schedule a group class.
  
*Name
                          *required fields

*E-mail Address
 

*Confirm E-mail
 

*Telephone
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Home Address:
Street Address

City

State, Province

Zip Code

Country
AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean territoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, Democratic RepublicCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)Croatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea (north)Korea (south)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (FYROM)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis and Futuna IslandsWestern SaharaYemenZaireZambiaZimbabwe

Your personal information will not be sold or shared.

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PREVIOUS YOGA - QIGONG EXPERIENCE
How would you describe your current level?
Hatha yoga
no experience    beginner     intermediate
advanced      teacher

Qigong - chi kung
no experience    beginner     intermediate
advanced      teacher

Meditation
no experience    beginner     intermediate
advanced      teacher

What attracted you to mand^hira yoga?


What traditions have you participated in before  (for example, Anusara, Kripalu,
Ashtanga, Iyengar, CorePower, Bikram, SRF, Ananda, Tai Chi, etc.)


Do you have any experience doing inverted yoga postures? (shoulderstand,
headstand, viparita karani asana, handstand, etc.)
Yes    No   

Would you feel comfortable doing inverted postures in the course you are
registering for?
Yes    No    Not sure right now

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YOGA KNOWLEDGE
This information will help us tailor each course to our students' needs.  Don't worry
if your answers are "no".

Are you familiar with...
Yes    No     1.  kapalabhati
Yes    No     2.  mula bandha, uddiyana bandha, jalandhara bandha
Yes    No     3.  nadi shodhana / anuloma viloma pranayama
Yes    No     4.  chakras
Yes    No     5.  nabho mudra / khechari mudra
Yes    No     6.  microcosmic orbit
Yes    No     7.  kundalini (concept)

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*HEALTH
How would you describe your general health?
  excellent    good    poor    I have issues

*Do you have any health concerns that your teacher should be made aware of?

high blood pressure	heart and/or lung issues
diabetes	stroke
pregnant	smoker
back trouble	surgeries
medications	wheelchair
Please explain these or other health issues that you have:

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Please check over your registration form.  When you are ready, click
"CONTINUE" below.   [If you missed any required information above, you will be
asked to fill it in and resubmit.]

Note:  All participants will be required to sign a standard insurance waiver
before participating - required by yoga teacher insurance provider.

Next, you will be directed to STEP TWO, the PAYMENT page.

If you encounter problems with registering or making a payment, please contact us. 
You should receive an e-mail confirmation of your registration and payment from us
within 48 hours, in addition to a separate payment receipt from PayPal.

Thank you for being part of mand^hira yoga!
  

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