First Name*:

Last Name*:

        Email*:     Phone:

     Address:

            City:   State:

              Zip:   Country:

Please select your teacher (required): ---Sianna ShermanStacey Rosenberg & Darcy Lyon

When did you complete your 100 hour immersion?

Where did you complete your 100 hour immersion?

With which Certified Anusara Teacher did you complete your 100 hour immersion?

Do you have any injuries or medical issues?  Yes No

Are you taking any medications?  Yes No

How long have you been practicing Hatha yoga?

How long have you been practicing Anusara Yoga? Less than 1 year1-2 years2-3 yearsMore than 3 years

My level of understanding regarding Anusara's Universal Principles of Alignment is: ModerateStrongVery Strong

Please list with whom you study Anusara Yoga and any workshops or training you have taken.

Please list your most influential yoga teachers other than the Anusara Yoga teachers that you listed above.

Do you teach yoga?  Yes No

If not, are you interested in continuing toward teacher training?  Yes No

How many years have you been teaching yoga ?

What style(s) do you teach?

How did you hear about this program?  Google Facebook Yoga Tree Website Printed Ad Friend Referred Me Yoga Teacher Referred Me Other Other:

We would love to thank the person who referred you if you are willing to tell us who it is. . .

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