Location of Training  * 1 : : Dolphin Bay, Ballina Dolphin Bay, Ballina  1 : : Okinawa, Japan Okinawa, Japan  1 : : Vrindavan, India Vrindavan, India   1 : : Canggu, Bali Canggu, Bali   1 : : Please select Please select 

Date of event  * 1 : : Please Select Please Select  1 : : 04 December 2011 - 15 December 2011 04 December 2011 - 15 December 2011  1 : : 03 January 2012 - 31 January 2012 03 January 2012 - 31 January 2012  1 : : 03 January 2012 - 03 February 2012 03 January 2012 - 03 February 2012  1 : : 17 January 2012 - 31 January 2012 17 January 2012 - 31 January 2012  1 : : 30 January 2012 - 03 February 2012 30 January 2012 - 03 February 2012  1 : : 03 March 2012 - 01 April 2012 03 March 2012 - 01 April 2012  1 : : 10 April 2012 - 21 April 2012 10 April 2012 - 21 April 2012  1 : : 23 May 2012 - 20 June 2012 23 May 2012 - 20 June 2012  1 : : 23 May 2012 - 23 June 2012 23 May 2012 - 23 June 2012  1 : : 19 June 2012 - 23 June 2012 19 June 2012 - 23 June 2012  1 : : 30 June 2012 - 28 July 2012 30 June 2012 - 28 July 2012  1 : : 30 June 2012 - 31 July 2012 30 June 2012 - 31 July 2012  1 : : 27 July 2012 - 31 July 2012 27 July 2012 - 31 July 2012  1 : : 01 August 2012 - 29 August 2012 01 August 2012 - 29 August 2012  1 : : 01 August 2012 - 01 September 2012 01 August 2012 - 01 September 2012  1 : : 28 August 2012 - 01 September 2012 28 August 2012 - 01 September 2012  1 : : 24 September 2012 - 04 October 2012 24 September 2012 - 04 October 2012  1 : : 04 October 2012 - 01 November 2012 04 October 2012 - 01 November 2012  1 : : 04 October 2012 - 04 November 2012 04 October 2012 - 04 November 2012  1 : : 31 October 2012 - 04 November 2012 31 October 2012 - 04 November 2012  1 : : 04 December 2012 - 15 December 2012 04 December 2012 - 15 December 2012  1 : : 09 January 2013 - 19 January 2013 09 January 2013 - 19 January 2013  1 : : 18 January 2013 - 22 January 2013 18 January 2013 - 22 January 2013 

Last name  *

Email  *

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Address  *

City / town  *

State / region  *

Post / zip code  *

Country  *

Occupation  *

Gender  * 1 : : Male Male  1 : : Female Female 

Do you need an interpeter for the duration of teacher training?  * 1 : : Yes Yes  1 : : No No  1 : : Please select Please select 

Are you travelling with friends who speak English?  * 1 : : Please select Please select  1 : : Yes Yes  1 : : No No 

Accommodation: Please list the type required & any other relevant info (see practical info for options)

Are you a YogaTeacher? 1 : : Yes Yes  1 : : No No 

Have you done a YTT with us before? 1 : : Yes Yes  1 : : No No 

If so, which one?

Why are you interested in the Teacher Training program?

Explain your willingness to be fully committed to the training

What do you hope to gain, learn, or focus on during the training?

Do you have any comments or questions?

Do you currently or have history of, suffering from an eating or exercise disorder? 1 : : Yes Yes  1 : : No No 

Do you use drugs? 1 : : Yes Yes  1 : : No No 

Do you smoke? 1 : : Yes Yes  1 : : No No 

Do you drink alcohol? 1 : : Yes Yes  1 : : No No 

Do you have any challenges in participating in physical activities? 1 : : Yes Yes  1 : : No No 

Do you have any current or past injuries? 1 : : Yes Yes  1 : : No No 

Do you require assistance during the course due to the above injury or medical condition? 1 : : Yes Yes  1 : : No No 

Do you have any special dietary requirements 1 : : Yes Yes  1 : : No No 

If you answered YES to any of the above, please give details

Emergency Contact phone (please include area code and country code)  *

I agree that I must communicate with my teachers, at any time if I feel unwell or injured during the course.

I agree and understand it is my responsibility to ask my teachers if I do not understand any particular concept that is taught during the course.

I understand that drugs are not permitted on the onsite Accommodation or the Yoga Shala.

I understand that if I consuming any type of drug during the Training, such as marijuana, cocaine, etc, Santosha has the right to ask you to leave the course.

I agree that photos taken by Santosha during the course may be used for other purposes such as advertising

I agree that once the course has commenced Santosha can not refund any monies. If the situation has extenuating circumstances, Santosha will gladly discuss this further.

Please select a payment option 1 : : Please select Please select  1 : : Direct Deposit Direct Deposit  1 : : Paypal Paypal  1 : : Money Order Money Order  1 : : Personal Cheque/Check Personal Cheque/Check  1 : : Credit Card Credit Card 

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