Gertrude Street Yoga 200hr Teacher Training Application Form Step 1 of 6 16% Personal DetailsName* First Last Preferred Name and Spelling for Certificate*Email* Phone*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Emergency Contact DetailsEmergency Contact* First Last Emergency Contact Email* Emergency Contact Phone* About YouEducation and Training*Please list your education and trainings (related and unrelated to yoga)Profession*What do you currently do for work?Something Unique*Please share something unique about yourself! YogaHow long have you practiced Yoga?*How would you describe your current yoga practice?*Name two of your Yoga Teachers*What styles of Yoga have you practice?*Check all that apply Hatha Vinyasa Yin Meditation Chanting Pranayama Hot Yoga Restorative How did you hear about this training?*Google/WebsiteSocial MediaFriendOtherWho recommended it?What made you choose this training? What appealed to you?*What is your primary motivation for taking this training? Do you want to teach?* Health and WellnessDo you have any ongoing physical or emotional health concerns we should be aware of?* Yes No Please describe any ongoing health concerns*Do you have any health conditions that are likely to require attention during the training?* Yes No Please describe any health conditions*Do you have any allergies?* Yes No Please list your allergies*Are you currently taking any medication?* Yes No Please list your medications*What is your level of oral and written proficiency in english?*ExcellentGoodOkayOther Payment DetailsSelect a Training*February 2019June 2019Pricing*Earlybird + GSY Member: $4230Earlybird: $4,700Full Price + GSY Member: $4950Full Price: $5,500Are you applying for the $500 scholarship?* Yes No Please share what the scholarship would mean to you Agreements* I understand that 1+ year of experience practicing yoga is recommended before attending this training * I understand that once my application has been accepted my deposit is non refundable * I understand that I must make my deposit before my application will be processed * I understand that missing more than 3 days may result in loss of certification Cancellation Policy*30+ days before course start date: 100% refund (minus the $500 deposit) 20-30 days before the course start date: 50% refund (minus $500 deposit) 10-20 days before the course start date: 25% refund (minus $500 deposit) 0 – 10 days before the course start date: No refund If for some reason you are unable to complete the course once you have started we will find the best course of action on a case by case basis. I have read and agree to the cancellation policy Photo*Please upload a headshot of yourself
