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Svastha Yoga Therapy Program
Registration Form

Kia ora!

Thanks for your interest in attending the Svastha Yoga Therapy Program. I’m delighted that you are wanting to join the program and I look forward to sharing the journey with you.

Please take the time to complete the registration form below and I will be in touch to confirm that your registration has been received and forward payment details.

If you have any questions at all, please email me below.

Thanks again.
Ngā mihi
Barbara

Contact Barbara

About You:
Your Name*
First Surname
Which module are you registering for?*
- Module 1 - Dates TBA
- Module 2 - Dates TBA
- Module 3 - November 2019
- Module 4 - April 2020
- Module 5 - September 2020
- Module 6 - Dates TBA
- Module 7 - Dates TBA
Email Address*
Enter Email Confirm Email
Contact Phone Number*
Address*
Street Address Address Line 2 City Post Code Country
Emergency Contact Details*
Name Telephone Number Relationship
How did your hear about this program?*
- Recommended by a friend
- Google search
- Social Media
- Newsletter
Are you a Yoga Teacher?*
- Yes
- No
If 'Yes' please provide details of your training below.
Yoga Teacher Training Details*
Occupation (if other than Yoga Teacher)
Do you have any injuries or illness that it would be useful for us to know about?*
Would you like to subscribe to Barbara's newsletter and be updated on future programs, workshops & latest news?*
- Yes please
- No thanks
Note: your information will never be shared and you can unsubscribe from the newsletter at any time.
Phone
This field is for validation purposes and should be left unchanged.

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Yoga Therapy Training Registration