Registrant Information:

*Full Name:

*Mailing Address:

*City:

*State:

*Zip:

Country:

Province:

Phone (H):

Phone (W):

Fax:

*Email:

Select Program Level 1 Level 2 Practitioner Level 3 Group Facilitator Module A Module B Location Bristol, Vermont Asheville, North Carolina Atlanta, Georgia Austin, Texas Chicago, Illinois Denver, Colorado East Lansing, Michigan Feathered Pipe Ranch, Montana Gray Bear Retreat, Tennessee Harbin Hot Springs, California Lenox, MA London, Ontario Los Angeles, California New Orleans, Louisiana New York, New York Oakland, California Orlando, Florida Portland, Oregon Rhinebeck, New York San Diego, California Seattle, WA Silver Spring, Maryland St. Augustine, Florida Tampa, Florida Tempe/Phoenix, Arizona Toronto, ON, Canada Vancouver, BC, Canada Sydney, Australia Date January February March April May June July August September October November December 2010 2011 2012 2013  

Select Program Level 1 Level 2 Practitioner Level 3 Group Facilitator Module A Module B Location Bristol, Vermont Asheville, North Carolina Atlanta, Georgia Austin, Texas Chicago, Illinois Denver, Colorado East Lansing, Michigan Feathered Pipe Ranch, Montana Gray Bear Retreat, Tennessee Harbin Hot Springs, California Lenox, MA London, Ontario Los Angeles, California New Orleans, Louisiana New York, New York Oakland, California Orlando, Florida Portland, Oregon Rhinebeck, New York San Diego, California Seattle, WA Silver Spring, Maryland St. Augustine, Florida Tampa, Florida Tempe/Phoenix, Arizona Toronto, ON, Canada Vancouver, BC, Canada Sydney, Australia Date January February March April May June July August September October November December 2010 2011 2012 2013  

Deposit Amount
Please check the deposit amount(s) you will be paying for.

Please write down your calculated total. You will have to enter that DEPOSIT TOTAL when making your credit card payment through our secure, online PayPal service.

Phoenix Rising Yoga Therapy Training
Level 1 - $100
Level 2 - $100
Level 3 - $500
Group Facilitator- $500

Phoenix Rising Yoga Teacher Training
Module A - $100
Module B - $100

Other Programs
Yoga With a Twist- $100

*Enter your DEPOSIT TOTAL here: $

Click the "Pay for Deposit Total" button to pay with a credit card
and complete your registration.