Kundalini Women

9 Sombrillo Road Española, New Mexico 87532 USA

 Tel +1-505-747 7411

Registration Form

Training:Conscious Pregnancy

Location: Española, New Mexico, USADate:July 6 - 19, 2009

Sat Nam,

Kindly complete the information in this Registration Form, the Release Form and your Payment Informationand forward to Tarn Taran Kaur Khalsa via email (), post (Tarn Taran Khalsa/ Conscious Pregnancy/ 9 Sombrillo Road/ Española, NM 87532). For any questions: call +1-505-747 7411. Thank you.

Personal Information

Legal Name:
Last / First / M.I.
Spiritual Name:
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Home Phone: / ( ) / Alternate Phone: / ( )
E-mail Address:
Birth Date: / Marital Status: / Children/ ages:
In case of an emergency, who should we contact?
Name & relationship / Phone number / ( )

Teaching Background

Are you a KRI certified Kundalini Yoga Teacher, Level I? / How many years have you practiced Kundalini Yoga?
Where did you complete your training? Who was your lead trainer?
How many years have you taught Kundalini Yoga?
How many years have you taught pregnancy yoga?
Are you presently an active member of IKYTA?

Emergency Contact Information

Full name contact person:
Last / First / M.I.
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Primary Phone: / ( ) / Alternate Phone: / ( )
Is there anything we should know about your health or personal situation?

Certificate Name Form

Students who complete all requirements of Conscious Pregnancy Training will receive a certificate. Your certificate name may have both your legal name and a spiritual name. Your legal name is required. Please indicate if you would like both a spiritual name and a legal name or only your legal name to appear on your certificate.KINDLY PRINT CLEARLY.
Your Name(s)
My legal name is ______.
My spiritual name is ______.
I request my certificate:
List Only My Legal Name on my Certificate
I request that my legal name appear on the KRI Certificate as written below.
Legal Name: ______.
List Both a Spiritual Name and a Legal Name on my Certificate
I request that both names appear on the KRI Certificate. I request that the names appear on the KRI Certificate in this order, as written below:
This name appears first______.
This name appears second______.

Yoga Experience

If you are not a certified Kundalini Yoga Instructor, explain your Kundalini Yoga or other yoga experience.

Teacher Association Member

In order to receive CEU (Continuing Education Units) for this Conscious Pregnancy Training, students must be a member of a Kundalini Yoga teacher association.
I am presently a member of IKYTA
I am presently a member of the national KYTA (Country:______)
I am presently a member of Yoga Alliance
I am a member of another national yoga teacher association If yes, what is the name of this yoga association and in what country?______
Signature ______Date ______

Looking forward to meet you and share Yogi Bhajan’s teachings for women. Sat Nam. Thank you.

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