RYACMP Enrollment Form

Fill in the enrollment form below and submit to go to the next step to complete the enrollment process

Full Name: *

First

Middle

Last

Email Address: *

Phone Number: *

Gender: *

Male
Female
Other

Date of Birth: *

MM-DD-YYYY

Address: *

Format: Unit Number, Street Name, City, State, Zip Code, Country

What is your intention to join this course (RYACMP)? *

I want to gather knowledge
I want to keep learning
I just need a certificate
I want to be a qualified Yoga practitioner
I need YA Continuing Education credits
Other

If you choose "Other" on the above question, please describe here:

Which mode of study are you interested in enrolling in? *

Name to appear on your certificate: *

Please enter the correct spelling & capitalize each word. This is the name will be printed on your certificate.

Tick anything that applies to your health condition: *

Diabetes
Thyroid
Asthma
High Blood Pressure
Arthritis
Migraine
Hormonal Problem
Broken Bone
Cholesterol
Back Pain
Wheezing
I'm Fit & Healthy

Are you fully vaccinated against COVID-19? *

Yes, I am fully vaccinated.
No, I am not fully vaccinated.
I never took COVID-19 vaccination.

Have you learnt or practiced yoga or meditation previously? *

How did you hear about Rhythmic Yoga Academy? *

A Friend of mine told
Yoga Alliance Directories
Social Media (Facebook / Instagram)
Newspaper
Television Commercial Ads
Recommended by Insurance Agents
Google / Bing Search
New York TimeSquare Billboards
YouTube Commercial Ads

When you tick the box below, you are agreeing for the Terms & Conditions mentioned below: *

I agree that all information I mentioned above are valid true. And I am allowing Rhythmic Yoga Academy to contact me regarding yoga classes, courses, events and schedules.

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