Rolf Gates

Rolf Gates: master yoga teacher & author

Casa Grande Mountain Retreat, Puerto Rico
July 2010 + March 2011

Back Bay Yoga, Boston MA
October 2010-April 2011

Charlotte Yoga, Charlotte NC
Feb - Oct, 2010

Cross Gates Family Fitness
Slidell, LA
Jan - Oct, 2010

Hot House Yoga, Virginia Beach, VA
Feb 2010-June 2011

200hr Vinyasa Teacher Training
Back Bay Yoga, Boston MA
October 2010-June 2011
www.backbayyoga.com

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?

Describe your perfect life:

Is there anything else you would like us to know?

PAYMENT OPTIONS:

	OPTION I: $2850 EARLY REGISTRATION FULL PAY: Pay in full by May 1st, 2010: ($350 discount)

	OPTION II: $3000 EARLY REGISTRATION PAYMENT PLAN: Pay a $500 deposit by May 1st, 2010 ($200 discount)

	OPTION III: Payment Plan $500 Deposit with 9 consecutive monthly payments of $300

*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.

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