Ayurveda Nutrition Registration Form - Wise Living Yoga Academy

Please choose from below which batch do you want to attend.*

Choose Course Date*

Personal Details

Please tell us about yourself.

Name

First Last

Gender*

Age*

We would like to send you confirmation by Whatsapp- What is your Whatsapp number?*

Email*

Facebook or instagram

Nationality*

Emergency Contact Person (Name) & Relation (e.g. mother, husband, etc)*

Phone number & E-mail of Emergency Contact Person*

How did you know about our Ayurveda Course? (Facebook, FB group, Website please be specific thank you)*

Please write in the name of who referred you

Medical History

Please give us detailed information about any health conditions

What is your present health condition?*

Do you have any of the following special conditions?

Health Details (If Any)

Are you taking any medicines?

Medicines

About Yoga Previous Experience & Motivation

Please give us detailed information about your Yoga experience and motivations.

Do you have any previous experience with any such courses?*

What is your personal motivation for joining this course?*

Any Further Comments

By checking the box below you confirm that you are aware and you agree with the Rules & Regulations of Wise Living Yoga Academy regarding the Code of Conduct and the Payment & Refund Policy for the Yoga Teacher Training Course.

Yes I Agree

Please pay the full course fees + 7.5 % Paypal Charges.

OR

Book your space by paying the registration fees of USD 100.

Enter Amount*

Total

$0.00