IYT Program Registration

To register online, fill out this form and click submit. To register by check, please print this form and send by mail with your check.

First Name Middle (optional)  Last

Address

City  State  Zip/Postal Code Country

Day Phone  Evening Phone

Provide a valid e-mail address and you will receive a copy of this form as confirmation

E-mail

Comments

$295 non-refundable deposit holds your space. Balance is due three weeks prior to training. Deposit is transferable to another program with notification by this date.

Payment Information:

Discover

American Express

Mastercard

Visa

Credit  Card #

Expiration  date

CVV Code

Amount

Select program and housing option:
	DaySpring Dorm DaySpring Double DaySpring Single Enchanted Mtn Double Enchanted Mtn Single Pura Vida Camping $848 Pura Vida Double $1235 Pura Vida Single $1638

To register by check, please print this form and send by mail with your check. To finish your credit card registration online, click the Submit button below.

Integrative Yoga Therapy 1161 East Marion St #179 Shelby NC 28150 (800) 750-9642 / (415) 670-9642 www.iytyogatherapy.com e-mail: info@iytyogatherapy.com

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Pre-Program Information Form