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Breathe, Move, Feel with Passion and Purpose


	Synergy Teacher Training Application Form
	An interview in person or by phone is required to confirm acceptance into the program. Please call 305-534-9807 or email the director at gaiamylove@yahoo.com to arrange an interview. To Apply Online Complete the form below and click submit. You can also apply by mail.


Name
Email Address
Address
City
State, Zip
Home Phone
Work Phone
Mobile Phone
Occupation
Age	Gender
Emergency Contact

1. How/from who did you hear about Synergy's teacher training? Be specific.


2. What do you wish to accomplish by taking the course?

3. Tell us about your yoga background and include:
how long you have been practicing and how often do you practice; do you have a personal daily practice, if yes describe it briefly; what style or styles do you practice; who are your most important influential teachers; list yoga workshops or trainings you have participated in and anything else that you think is important about your experience with yoga.


4. Do you have any current or past injuries or physical issues that affect you now?

5. Have you ever taught yoga? If so, where, when, for how long and what style?

6. Please describe any previous training or formal study in bodywork, spirituality, psychology, counseling, etc;

7. Are you currently taking any medication? If so, please advise.

I, the undersigned, being of sound mind and body, do willfully choose to join the Synergy Teachers Training Course. I understand that yoga is a rigorous discipline and I accept full responsibility for every thing that happens to me during the course. I agree to pay Synergy 50% of the tuition prior to the beginning of the course, with the balance to be paid in full no later than the 4th of January, 2010, unless other arrangements have been made with the director. A refund minus $200 will be made of all cancellation requests in writing postmarked by January 9th, 2010. Absolutely no refunds will be made after January 9th, 2010. I understand that if I decide to quit the course at any time, there will be no refund of tuition. I understand that I must complete all certification requirements as outlined in the “Criteria for Successful Completion” document in order to receive the Synergy 300-hour professional certification diploma.

Note: we will ask you to sign the application in person during the interview.
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After clicking submit, you will be redirected to a confirmation page.

GaiaLivingArts.com | Tel. 305-534-9807 | Email info@gaialivingarts.com