Wufoo

Name * First Last
Email *
Telephone Number *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Gender *
Female Male
Age *
Please describe your general state of fitness. *
Please give an overview of your level of experience in yoga including the style(s) of yoga with which you are most familiar. *
Do you currently have a home practice? How often do you practise yoga each week? *
Are you currently certified through any other yoga teacher training programme? *
What is your intended goal with the knowledge you will gain from this course? Please describe your expectations. *
Please list any medical concerns of which we should be aware (including allergies). Are you taking any medications? If so, what for? *
Please state your reasons for choosing Ashram Yoga's teacher training course. *
Emergency Contact

1. Name
2. Telephone number (plus country code if outside NZ)
3. Email address *
Comments or Queries
I affirm that all of the information provided by my own report is true and accurate to the best of my knowledge. I plan to honour my commitment to the teacher training course and to all requisite elements described. I further commit to honour my fellow students and their privacy and to respect them as individuals.

I will abide by the instruction given to me by my teacher trainers and express any concerns or reservations I may have without bias. I fully understand that I am responsible for my own person, my course materials and my state of physical readiness as a participant in this course. I will hold no liabilities against any person, agent or establishment associated with the participation and/or design of this course.

I give my consent for photos, videos and other media taken of me during the course to be used in Ashram Yoga's promotional material.

I agree to pay the total cost of tuition. I understand the $500 deposit becomes non-refundable 30 days before the course starts. I understand that if I withdraw from the course after paying in full, then the course fee will be refunded to me less the $500 deposit (if it is within 30 days of the course starting), and less any bank transaction fees. There is a surcharge of $50 for administration fees. I understand that once the course starts no money will be refunded. I understand that payments through Paypal or by credit card will incur an additional charge of 4%.

Please contact us if you want to pay by Paypal.

All figures are in New Zealand dollars.

My agreement is binding on all these points. *
I accept these terms and conditions.
Would you like to pay by *
Bank transfer Credit card

Bank transfer: we will email you our account details for domestic and international payments.

Credit card: payments incur an additional 3% for transaction fees. Your card details will be collected when you submit this form.
Payment by bank transfer *
May 2018, $500 deposit May 2018, $4950 regular rate February 2019, $500 deposit February 2019, $4700 early bird rate February 2019, $4950 regular rate
Payment by credit card including 3% transaction fee *
May 2018, $500 deposit May 2018, $5100 regular rate February 2019, $500 deposit February 2019, $4840 early bird rate February 2019, $5100 regular rate
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