Texas Yoga Retreat

Living Yoga Program Registration – Yoga Register (YR) Track

Name...... Male____ Female ____

Address......

City/State/Zip......

Daytime Telephone ( )...... Evening Telephone ( )......

E-mail address ......

Emergency contact name/relationship...... Contact phone ......

By completing this form, I certify that I have read the refund policy (from the LYP Application Form) and agree to its provisions. Initials ______

Modules 1-4, along with completion of your “Graduation Notebook,” are required for certification through the Living Yoga Program - YR Track.

Module 1 (100 hrs). The 9-day Foundations Training must be completed through LYP at Barsana Dham ashram in Austin, Texas. Choose one of the intensive dates below.

Module 2 (20 hrs). Anatomy is available through LYP as an on-site 2-day training at Barsana Dham ashram in Austin, or on-line through the LYP website for free. You can also take Anatomy through a program of your own choosing, or even receive credit for Anatomy classes you have already taken, subject to approval by your advisor.

Module 3 (50 hrs). Asana classes can be taken with your choice of teachers in your community, or through workshops, retreats or conferences. All classes must be written up in class logs. Guidelines for writing class logs can be found in the student section of the LYP website.

Module 4 (30 hrs). Self-Study. Guidelines and suggestions for completing your self-study can be found in the student section of the LYP website.

Graduation Notebook. To graduate from the Living Yoga Program’s YR Track you will need to submit a “Graduation Notebook” that includes a certificate of completion for Modules 1 & 2, along with your 50 hours class logs from Module 3, and your 30 hrs of self-study notes from Module 4. Please allow one month for your advisor to review your work and return your notebook to you, along with suggestions for improvement, or notification of graduation from the program. Information about the Graduation Notebook can be found in the student section of the LYP website.

EVENT REGISTRATION AND FEES - Prices include all meals (delicious vegetarian food) during training.

TOTAL EVENT FEE (Subtotal 1): $______

ACCOMMODATION FEES – Accommodations at Barsana Dham are not included in the Event fees. On-site accommodations are required for Module 1, but are optional for Module 2. Beds are twin and include sheets, blanket, pillow, towels, and soap. Fill out the information below to calculate your accommodations costs. Place a “” by the room choice you prefer (e.g. shared bath or bath in room).

TOTAL ACCOMMODATIONS FEE (Subtotal 2): ______

*Name of person(s) with whom you would like to share a room, if applicable ______

If you are staying in shared rooms and do not have a preference, we will place you with a roommate(s). * Although we will try our best to accommodate your roommate choice, we cannot guarantee this due to room availability and total number of attendees at the retreat.

GRADUATION NOTEBOOK REVIEW FEE

It can often take hours for a Living Yoga Program faculty member to thoroughly review a graduating student’s Graduation Notebook. Therefore, we have a $150 fee for this service which also covers mailing the Graduation Notebook back to you, along with your certificate.

TOTAL GRADUATION NOTEBOOK REVIEW FEE (Subtotal 3):$150.00

PAYMENT

A $150 non-refundable deposit reserves your place. The balance of your fees is due 30 days prior to the event.

______Total Events Fee (Subtotal 1)

______Total Accommodations Fee (Subtotal 2)

____$150.00_ Total Graduation Notebook Review Fee (Subtotal 3)

______Grand Total (check payment method below)

______Amount I am paying now (a minimum of $150 non-refundable deposit will hold your place)

______Amount still owed to Living Yoga Program, if applicable

______Pay by Check or money order (payable to the Living Yoga Program)

______I authorize Living Yoga Program to charge my Credit Card (Visa, MasterCard, Discover) for the dollar amount above.

______I have already gone to the Living Yoga Program website and charged my credit card for the amount above.

Name on card______

Card type: ____Visa ____ MasterCard ____ Discover

Expiration Date (mm/yy)______

Card Number ______

TOTAL Amount to charge: ______

MAIL REGISTRATION TO:

Living Yoga Program

8206 Stillwood Lane

Austin, Texas 78757

Attn: Ellen B. Smith

512-266-7926

Once registered, we will E-mail a receipt and additional information about the program to you.

Building a caring, diverse, and empowered yoga community.