Rolf Gates

Rolf Gates: master yoga teacher & author

VINYASA TEACHER TRAINING APPLICATION
Bucksteep Manor, Washington, MA
July 14th-August 1st, 2008

Thank you for you interest in our Teacher Training Certification Program. Take your time in filling out this application. Namasté

CONTACT INFO

First Name:			Last Name:
Street Address:
City:			State:
Zip Code:			Country:
Daytime Phone:			Evening Phone:
Email:

Company:			Marital Status:
Occupation:			Gender:
Age:

PHYSICAL HEALTH

Under physician's care? Yes No

If yes, for what reason?

Epilepsy? Yes No

Diabetes? Yes No

Are you currently seeking mental health care? Yes No

If yes, for what condition?

Please list any current medications:

Have you ever been hospitalized? Yes No

If yes, for what condition?

Do you have any dietary requirements?

What is your past history with yoga practice? Please include any previous workshops or intensives with Rolf Gates.

INTENTION SETTING:
Please take a moment to write down what you want out of this Teacher Training. There is a power in writing down goals, sharing them and then referring to them often. What is your intention for taking this program?

What are your biggest challenges in life?

Describe your perfect life:

Is there anything else you would like us to know?

ROOMING PREFERENCE & PAYMENT (subject to availability)

$1250 (Manor House: Double Room/Shared Bath)
	(+$2100)=$3350 paid in full

	$500 deposit ($3000 due by Feb 1st, 2008)

	$500 deposit (Please send me payment plan contract)

$1600 (Manor House: Private Room/Shared Bath)
	(+$2100)=$3700 paid in full

	$500 deposit ($3350 due by May 1st, 2008)

	$500 deposit (Please send me payment plan contract)

$1650 (Cottages: Double Room/Double Shared Bath)
	(+$2100)=$3750 paid in full

	$500 deposit ($3400 due by May 1st, 2008)

	$500 deposit (Please send me payment plan contract)

$1850 (Cottages: Private Room/Private Bath)
	(+$2100)=$3950 paid in full

	$500 deposit ($3600 due by May 1st, 2008)

	$500 deposit (Please send me payment plan contract)

*The schedule of payments will be determined by your selection in your payment plan contract. This will be sent to you upon receipt of your application and payment choice.

Please note that upon acceptance of your application a $500 non-refundable deposit will be charged.

The remainder of your balance will be charged on May 1st, 2008/or based on the schedule in your payment plan contract.

Contact Mariam Gates with any payment inquiries.

Refund/Non-Refund Policy: Cancellations must be made 60 days before the start of the Teacher Training. We can not offer any refunds for cancellations within 60 days of the event, but a credit towards a future Teacher Training Program may be available.

Contact Mariam Gates with any payment inquires, 617-271-7106 (direct line). You may also mail your payment check to:

Gates Yoga
PO Box 421
Santa Cruz CA, 95060