| Which Immersion/Training are you Applying for? |
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| First Name |
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| Last Name |
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| Email |
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| Address |
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| City |
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| State |
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| Mobile Phone |
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| Home Phone |
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| Date of Birth |
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| Emergency Contact |
| Name |
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| Phone |
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| Your Health |
| Do you have any physical injuries or medical conditions? |
yes no |
| If yes, please describe. |
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| Are you taking any medications? |
yes no |
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| Yoga History & Experience |
How long have you been practicing hatha yoga?
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| How long have you been practicing Anusara Yoga? |
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| What is your level of understanding of Anusara's Unviersal Principles of Alignment? |
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| Please describe your personal practice: |
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| Why do you practice Yoga? |
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| Why do you want to take this particular training? |
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| Please list any and all immersions, workshops, trainings and classes you have participated in with Certified Anusara Teachers. |
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Do you currently teach yoga?
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yes no |
| If so, what style and for how many years? |
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What else do you bring to your training?
Please tell use about any other trainings, healing modalities, retreats and personal work you have engaged in. |
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Why does wild success at your Immersion/Teacher Training look like for you?
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| Is there anything else you would like us to know? |
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