Membership Application

Name(required)

Email(required)

Phone(required)

What is your intention for joining?

200 Hour 500 Hour Other Certifications

Certifications

Where and when were your certifications completed

How did you hear about this group?

Do you currently teach? If so where?

Yes No

If you do not teach, do you want to?

What do you hope to get from this group?

Would you be interested in an add-on mentorship program, Ashtanga, something else?

What topics would you like to see discussed?

Are you interested in a retreat? If so, where?

What types of guest speakers would you be interested in hearing from?

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