Name:_______________________________________ Date: _____________________
Address: _____________________________________
____________________________________________
____________________________________________
Tel. number (home) (_____)_____________________
Tel. number (mobile) (_____)_____________________
Te. number (work) (_____)_______________________
Email: _______________________________________
Registering for ___ class ___ workshop/retreat
Title:___________________________________
Dates:__________________________________
Fee: $____________
Deposit $__________ (1/2 fee to hold your space)
Payment method: ____check (send to YogaNOW @ P.O. Box 722 Brunswick, ME 04011)
____ Credit/Debit Card _____Master Card _____ Visa
Acct. # _______-_______-_______-_______ Exp.: ___/___
(Required) * Email address: __________________________________
(If different from above: Billing Address and phone number:)
Address______________________________________________________
______________________________________________________
______________________________________________________
Phone: (_____)_________________
Copy and email to Lisa - at: YogaNOW@gwi.net or mail to YogaNOW Studio
P. O. Box 722 Brunswick, Maine 04011