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About
Online Courses
Onsite Courses
Gallery
Blog
Contact Us

Short Term Programs Registration Form

Application Form for Online Short Term Programs

Module 1 / Module 2 / Module 3

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Proceed to fill the form

*Required
Please choose from below which batch do you want to attend.*
Choose Your Course*
Choose Your Course*
Choose Your Course*
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 Yoga Teacher Training 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?
- Diabetes
- Cardiac/ Hyper tension
- Depression
- Stress
- Orthopedic (herniated disc, joints, etc)
- Hypoglycemic
- Asthma / Bronchitis
- Ulcer (Stomach)
- Alergies
- Costipation / Indigestion / Acidity
- Surgeries (Recent or past) - Please give details
- Food intolerance
- Addictions (Cigarettes, alcohol, coffee, others)
- Other
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

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About Us

Wise Living Yoga Academy is an ashram based in the countryside of northern Thailand that offers residential yoga teaching training courses in traditional yoga throughout the year.

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