Name *

Name

First Name

Last Name

Email Address *

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

What is your yoga experience? (including asana, meditation, pranayama, etc) What styles? How long have you been practicing? Do you have any alignment based yoga experience? *

Describe any personal or professional studies that you think are relevant to this training. *

Do you have any injuries, chronic illnesses, or physical limitations?

Name a yoga teacher (or teachers) you admire and tell us why.

What are your intentions for taking this training? Do you plan to teach? What do you hope to gain from this experience?

Is there anything that would be helpful for us to know about your current mental/emotional health?

Is there anything else you would like to tell us?

Are you able to commit to all of the training dates? Are you aware of existing cancellation/make up policies? *

How did you hear about this training?

Check all that apply

Student of Kim

Student of Becca

Word of Mouth

Website/Google Search

Social Media

Yoga Alliance

Flyer/Poster

Other

Is there a specific need-based population to which you aspire to offer "accessible yoga"? What is your connection to/background with that population?

* This question is mandatory only for trainees applying for the "Susan Kay Hollingshead Accessible Yoga Scholarship."