Sampoorna Yoga - Application Form

Sampoorna Yoga Application Form page 1/2

Please fill this application form out, print it out, sign it and send it with your deposit
- check or money order payable to Nada Productions; no credit card! -
to Yogi Hari's Ashram - 12750 SW 33rd St. - Miramar, FL 33027 - USA

First Name:		Last Name:
Address:		City:
State:		Zip:
Country:		Home phone:
eMail:		Cell = mobile phone:
Date of birth:		Gender / age:
Occupation:
Special Talents & Skills:
Hatha Yoga practice since:		If Yes, method:
Meditation practice since:		If Yes, method:
I have tought Hatha Yoga (yes/no):		If Yes, please describe:
I learned about your course from:
Is English your primary language?		If not, what is it?

I sign up for:

Teachers Certification Course

2 weeks resid. from to
6 weekends from to

Advanced Teachers Certification Course

3 weeks residential from to

Special Event

Sampoorna Yoga Application Form page 2/2

First Name:

Last Name:

SYTCC, Weekend SYTCC	Enclosed is my deposit of $600	Enclosed is my full payment of $2000 ($1600 for returning students program *)
SYATCC	Enclosed is my deposit of $900	Enclosed is my full payment of $3000 ($2400 for returning students program *)
SYTCC & SYATCC	Enclosed is my deposit of $1500	Enclosed is my full payment of $4500 (10% disc.)
Yoga Day		Enclosed is my full payment of $45
Special Event		Enclosed is my full payment.

*) returning students program: valid for the 2 week SYTCCs in April and November, the Weekend SYTCC in August and the SYATCC in July

On a seperate sheet of paper please describe briefly your personal and occupational background
as well as the spiritual background that has influenced you to apply.

Please include a recent photograph.

Please make your check payable to "Nada Productions".

Please note: No refund on deposit once your application is approved.
In case of emergancy you may transfer your deposit once on another course.
Full payment is due before the course begins. No refund whatsoever after the course begins.

Signature: Date: