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Dancing Shiva Program Registration Form - OLD

Please enter your name

Please enter your address

Please enter your city

Please enter your state

Please enter your zip code

Please enter your country

Please enter a phone number

/ / Please select your birthdate

Please enter your email address

Please choose education completed

Please enter your major

Please enter your degree

Please enter year graduated

Please enter your current profession

Please choose career satisfaction

Please describe your Yoga and Ayurveda experience

Please describe your reasons for taking the program

Please describe your lifestyle

Please choose how many hours you have available

Please accept the terms and conditions

By checking this box you certify that you understand and accept the policies of the Yoga and Ayurveda Program. This also confirms that all the information you have provided is accurate and true. You are acknowledging that you have read and fully understand the program guidelines, the tuition, the fees and the payment options.