Yoga Teacher Training Registration Form

* Required

Select Your Program * -- Please select --200-hour Multidimensional Yoga Teacher Training (July 7 - Aug. 2 2013)108-hour The Anatomy of The Self Yoga Teacher Training (Aug. 4 - 14 2013 )200-hour Multidimensional Yoga Teacher Training (Jan. 5 - 31 2014 )108-hour The Art of Flow Yoga Teacher Training (Feb. 3 - 13 2014 )Integrative Healing Yoga Therapy Training/Retreat (June 16 - 22 2013)Other Yoga Retreat

Title DRMISSMRMRSMS

First Name *

Last Name *

Date of Birth *

Email Address *

I am * Male Female

Home Address *

City *

State *

Zipcode/Postcode *

Country * -- Select Country --AFGHANISTANALAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEAN TERRITORYBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGO, THE DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICACÔTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHOLY SEE (VATICAN CITY STATE)HONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRAN, ISLAMIC REPUBLIC OFIRAQIRELANDISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA, DEMOCRATIC PEOPLE'S REPUBLIC OFKOREA, REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLE'S DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIA, THE FORMER YUGOSLAV REPUBLIC OFMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIA, FEDERATED STATES OFMOLDOVA, REPUBLIC OFMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORY, OCCUPIEDPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIAN FEDERATIONRWANDASAINT BARTHÉLEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASERBIA AND MONTENEGROSEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDSSPAINSRI LANKASUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWANTAJIKISTANTANZANIA, UNITED REPUBLIC OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVENEZUELAVIETNAMVIRGIN ISLANDS, BRITISHVIRGIN ISLANDS, U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWE

Whom should we contact in case of emergency? *

Emergency Contact Number *

What is your relationship to your emergency contact? *

Describe your yoga experience and any mind/body practices in which you engage: *

Please specify any health concerns, medication, injuries or conditions. If you are seeing a health professional, do they recommend your participation in this training? *

Describe any hopes, goals or intentions for attending this training:

Why have you chosen Pavones Yoga Center as your place of study? *

Do you have any dietary restrictions?

Retreat Upgrades (non-yoga training only) -- Please select --I am registering for a retreat (double room included in price)I am registering for a retreat (single room add $70/day))

Yoga Teacher Training Upgrades, Offsite Options -- Please select --I don't want an upgrade and I will be staying onsite.I'd like to upgrade to a semi-private room for two (add $600)I'd like to upgrade to a triple room (add $300 USD)I will be staying and eating offsite (program fee only: $2900 USD)

How did you hear about Pavones Yoga Center? (check all that apply) * Yoga Journal Yoga International Yoga Alliance A friend An internet search Facebook/Twitter The Salty Dog (the PYC blog) PYC newsletter Other

Is there anything else you'd like us to know about you?

Terms And Conditions * By submitting this reservation request I certify that I have read and agree to Pavones Yoga Center's terms and conditions as listed on our FAQs page.

Enter Word Verification in box below *

COMPLETING YOUR REGISTRATION

In addition to completing this form, a $500 non-refundable deposit is required to reserve your space. You can secure your place in our yoga program or retreat by using the Paypal link below, or by sending a check in US dollars to our US billing address. Due to limitations within the Costa Rican banking system, we are currently not able to process credit cards online. If you would like to pay by credit card, please contact us for a credit card authorization form. Important: especially if you use gmail, you will need to add us to your contact list or check Junk Mail/SPAM for our reply.