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COURSE APPLICATION |
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Prénom | Vor | Nombre |
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First Name |
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Nom
| Zurname | Appellidos |
Last Name
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Course Name |
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Arrival Date |
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Departure Date |
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Accommodation
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Type |
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Alter | Edad |
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Age |
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Sex (M/F) |
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E-mail |
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Rue
& No. | Strausse u. Nr. | Calle |
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Street Address |
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Ville | Stadt |
Ciudad |
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City |
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Prov/State |
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Pays | Land | Pais |
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Country |
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Code Postal | PLZ |
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Zip Code |
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Privé | Privat | Casas |
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Home Phone |
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Travail | Arbeit | Trabajo |
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Work Phone |
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Occupation | Beschaneftigung | Ocupacion |
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Occupation |
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Éducation et Aptitudes | Ausbildung & Fachigkeiten |
Educacion & Capacidades |
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Education & Skills |
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Maladies | Krankheiten | Enfermedades
Médicaments | Medikamente | Medicamentos |
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Illnesses |
Prescribed Medications |
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Contact in Case of an Emergency |
Contacte en cas d'urgence | Kontaktadresse fuer Notfaelle | Contacto de
Emergencia
Rue & No./Ville/Pays/Code Postal | Stausse u. Nr./Stadt/Land/PLZ
| Calle/Ciudad/Pais |
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Address |
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E-mail |
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Phone |
Relationship |
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Depuis combien de temps pratiquez-vous le Yoga? – Yogapraxis seit
– Desde cuando esta ud praticando yoga |
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Length of time practicing yoga |
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Membre d’un centre Sivananda? Lequel? – Mitglied Sivananda
Zentrum, wo? – Este ud Miembro del Centro Sivananda, el cual? |
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Are you a member of a Sivananda Yoga Center? Which?
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Raisons pour vouloir prendre le cours | Warum moechten sie den kurs
nehmen | Rezones para tomar el curso |
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Taille d'uniforme | Kleider groesse | Talla uniforme |
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The cost of this course includes administration
& tuition. Students who choose to stay in a tent must bring their own
tent, sleeping bag, mat, towels and toilet articles. We recommend that you bring
with you a yoga asanas mat.
A NON-REFUNDABLE
DEPOSIT OF $150 US is
required when making your reservation.
Credit Card (Visa/MC/AmEx) Certified Cheque Money
Order
For credit card payments (Visa/MC/AmEx) please call The Yoga Retreat with your
credit card information at:
1-866-446-5934 / 1-242-363-2902 / 1-800-441-2096
Payment by
certified check or money order will be received by mailing it to our address
at
Sivananda Ashram Yoga Retreat, P.O. Box 195 N7550, Paradise Island,
Nassau, Bahamas
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For Fax
Applications:
Signed
Date
Signature - Unterscchrift Firma Date - Datum - Fecha
Signature of Parent
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Parental permission is required for those under age
eighteen
La permission des parents est demandé pour ceux agés de
moins de 18 ans - Die Unterschrift der Eltern ist erforderlich fuer alle unter
18 Jahre - Se Requiere permiso parental para menores de 18 anos
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