Prana Gyana
Local Yoga classes: Gilbert, Mesa, Tempe, Chandler
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Local Yoga classes: Gilbert, Mesa, Tempe, Chandler
 

 

Please complete the form to register for the
JUST BE! WORKSHOP

First Name:
Last Name:
Credit Card Billing Address:
City:
State:
Zip:
Phone Number:
(Home or Cell):
Email:
Male/Female?:
Age:
Occupation:
Month of Birth (spell it out):
Date of Birth:
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Place of Birth (City, State, Country):
Time of Birth (Include AM/PM):
Health Issues (Mental/Physical/Emotional):
Medications you are taking:
Emergency Contact Name/Phone Number:
How did you hear about the course?:
If other, please specify how:
Registration: Submit this form with full payment. Once we receive your registration, a confirmation letter will be emailed to you with more information.

Cancellation Policy: Your payment is non-refundable but is transferrable. Please let us know in a timely manner who will be taking your place. MC, Visa and checks are welcome.

My decision to take this workshop is a personal decision. I have not been made any promises or warranties that I will receive any benefits or specific results. I understand that lifestyle consultations and meditation are not a substitute for treatment or services ordinarily provided by health care professionals for physiological or psychological complaints. I further understand that any instruction given to me during the course is for me personally and may not be appropriate for others. I hereby agree to hold Anita Rangaswami, Prana Gyana LLC, and their officers, agents, and contractors harmless in any claims brought by me, or on my behalf, which contradict the above. Submission of this form constitutes my signature acceptance of the conditions expressed in the agreement.