Registration I’d like to get to know you better! All events/ sessions are pre-registered through this 5 minute intake form. Fields marked with a * are required. First Name * Last Name * Email * Phone * How did you learn about me? (Check all that apply) * Yoga 216The Bhakti CenterAthletaGolokaSt BartsFriends/ ReferralsOnline search I'm interested in (Check all that apply): Private 1-Day Yoga Cleanse StaycationPrivate 2-Day Yoga Cleanse StaycationPersonal Yoga Consultation & PracticeCandlelit Yoga Kirtan Urban RetreatMindful Movement RetreatsYoga WorkshopsYoga Teacher Training/ Mentoring Exercise and Lifestyle Lifestyle, exercise and dietary habits Yoga Experience and Expectations * What's your experience with yoga and meditation practice (number of years, styles, regularity)? Why are you coming here? Important Declarations * Medical history and current conditions (surgery, pregnancy, injuries, heart condition, high blood pressure, cholesterol, diabetes, asthma, joint or muscle pain, etc). What are your doctor's recommendations? Emergency Contact Person Name * Emergency Contact Person Email * Emergency Contact Person Phone * Agreement * BY CLICKING BELOW, I hereby accept and agree to the terms and provisions contained in the agreement.