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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe 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
