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Anusara Yoga Immersion with Kimber Spring 2010 Registration Form
Name _______________________________________________________________________ Email _______________________________________________________________________ Phone _______________________________________________________________________ Address ______________________________________________________________________
Emergency Contact Information Name _______________________________________________________________________ Phone _______________________________________________________________________
How long have you been practicing yoga, what styles and with what teachers? _____________________________________________________________________________ _____________________________________________________________________________
How long have you taken yoga with Kimber? _____________________________________________________________________________ _____________________________________________________________________________
How familiar are you with the Anusara Universal Principles of Alignment? (Circle one)
not at all somewhat good strong very strong
What do you hope to receive from the 50 hr Fall Immersion? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Payment information (Circle all that apply) I plan to pay the full amount ($550) by check. I have already paid the full amount by check. I need to create a payment plan. I have already paid a deposit in the amount of $___.
Please return your registration form and payment intention to Kimber before March 1, 2010, either by email, studio folder, or by mail to Kimber Simpkins 874 55th St Oakland, CA, 94608.
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