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Registration Form

Please fill in the information below to complete registration.

All information will remain confidential.

Training(s):

11-Day Challenge

Bhuta Shuddhi

Upa-yoga

Angamardana

Surya Kriya

Yogasanas Beginner

Review Session

* It is required that you attend all of the classes for each training that you register for.

First Name

Last Name

Phone number (no dashes required)

City

Zip Code

Briefly describe your experience with yoga and meditation.

Please mention if you currently have (or previously had) any health conditions? (e.g. major surgery in the last 6 months, injury, hernia, dislocation, asthma, depression, etc.).

What do you hope to achieve?

How did you hear about us?

Do you mind if I take photographs of you during the workshop? Sometimes I use these photographs for promotional purposes.

I do not mind being photographed.

I do not wish to be photographed.

Precautions

The following people should not do Surya Kriya, Angamardana and Yogasanas:

Pregnant women
People with serious back pain or injury
Anyone who has had a major surgery in the last 6 months
Anyone who has had laproscopic surgery within the last 6 weeks

As a general guide, always consult and follow your doctor's advice. If you have any questions please contact me at or 612-804-3385.

Release & Waiver of Liability Agreement

I have read and agree with the Release & Waiver of Liability Agreement.

Payment: Please submit payment via Venmo or Zelle

Thank you for registering.

Please check your email for confirmation.