Restorative Yoga Nidra Training Intake Form

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Registration Form - Therapeutic Yoga Training Online

First Name

Surname

Preferred Name and pronoun.

Address

Apt, suite, etc.

Country

City

State

Zip code

Mobile Phone

Date of Birth

Emergency Contact

Are you of aboriginal or Torres Straight Islander descent?

Yes

I would like to register for Restorative Yoga Nidra Method and Mindfulness - Online interactive course.

Starting Oct 13th: 8 wks 6.30 - 8.45pm Tuesdays

Bonus retreat workshop Sat Nov 28th 9am-12 AEST. No extra cost for course members..

Training For Health Professionals 8 weeks 8 Modules October 13, 20, 27, Nov 10, 17, 24 Dec 7, 14 Tuesdays 6.30 - 8.45 pm.

Do you have Yoga or Meditation/ Mindfulness experience?

Yes

Type of yoga, meditation, mindfulness experience

Do you practice meditation on a regular basis?

Yes

Are you a Health Therapist? For Allied Health Practitioners; What is your qualification eg Physio, Occupational Therapist, Psychologist, nurse etc

What are your areas of work/ career development?

What are your areas of special interest in this training?

Please explain if you have any physical conditions or health issues that we should be aware of.

I have read and agreed to the Terms and Conditions

Yes

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