Application

Complete the online form below or download application and return via email. Please note: After June 9, applications require a $100 fee. This fee goes towards tuition if you are accepted on the program. It is only refunded if we cannot offer you a space on the program. Paying this by internet will be available June 12 or you can send a check to MPaffard with Panca Bhuta Yoga in the Memo, to PO Box 225 Yorkville CA 95494.

Name *

Name

First Name

Last Name

Date of Birth

YYYY

Gender

Male

Female

Other

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Email Address *

Best contact times

Why are you interested in this program? What do you bring to a community-based program like this?

Please make sure you have read all the information on the web page before completing this form!

Please give a short history of your yoga and meditation practice? If you are a teacher and/or trainer/trainee, please give us an idea of your teaching experience, training and focus/style.

What is your current state of daily practice? Include if you practice pranayama and/ meditation here and for how long a period of time regularly?

What else do you do with your life besides yoga and how do you see this program being brought into your life?

What is your ecological and ayurvedic interest (if any), activity or aspiration at this time?

Can you attend the majority of weekends in the course? You must be able to attend a minimum of 80% of class hours and be OK with doing make-up contact hours which may require further payment.

Do you understand and agree to the payment agreement (below) and the refund/cancellation policy?

There are no refunds after June 9, 2018. In an emergency situation, a $500 administrative fee will be charged. After 8/1/18 there are no refunds under any circumstances. Please make sure you want and are able to do this program!

Any concerns or particular questions at this time?

Mentorship Hours:

You are required to attend 25 hours of classes/workshops with Richard/Mary and 22 class/workshop hours, three private sessions and 5-10 assisting hours with an approved mentor (or RR/MP). Do you know right now how you will complete this requirement? If you are not interested in teaching, will you still complete this part of the program?

Time Commitment:

a) Are you able and willing to commit to a minimum of 45 minutes of daily practice? Are you able to commit to yoga study and assignments that will take a minimum of 12 hours a month and could take much more if you so wished? b) You will need to purchase some books and access material sent by email/on web. c) Are you willing to check in with one other person in the group in person or on the phone during the month? Suggested time 20-30 minutes—in an ideal world, it would be a time to practice together and work on suggestions from the weekends. d) You will need to complete an assignment where you arrange to teach three classes as a volunteer to a group of your choice. Part of the last class (10-15 minutes) we ask you to record with the participants permission, and we will view/discuss in our final session. Are you okay with this assignment?

Terms

By checking this box, you are agreeing to the terms and conditions of the program and payment arrangements. We will notify you within two weeks of receiving your application if you are accepted onto the program. You will then have one week to decide if you wish to fully commit by paying the fee as outlined in Payment Information page.

Agree