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APPLICATION FORM

You will receive an email with the confirmation of your registration and an invoice.

Please answer the following questions as complete as possible. Fill out at least your name, telephone number and e-mail address so I can contact you.

Surname *:

First name :

Age:

Address:

Zipcode and Place:

Phone *:

E-mail address *:

Name of class/course or workshop:

Date and time of class/ course/ workshop:

Massage (30 or 60 min. and day and time of preference):

Physical and/or mental disabilities:

Date of delivery (Pregnancy Yoga):

Name partner (Pregnancy Yoga and Pregnant Together):

Midwife Practice/hospital (Pregnancy Yoga):

Name & age of baby (baby yoga & baby massage):

Name & age child (children's yoga):

And finally, please tell me how you found me:

	internet (e.g. Google)
	family / friends
	flyer
	otherwise:

* mandatory

The payment for the class/course is for 10 classes. These need to be finished in 12 weeks (national holidays excluded). If you subscribe you commit yourself to payment. The payment needs to be done before the start (by bank or cash on the spot). If the training is cancelled because insufficient participants, the money will be refunded. If you cancel yourself until seven working days before the start 50% of the money will be refunded. Later it will not be refunded.

Some insurance companies compensate (part of) the (pregnancy) yoga course. Inquire at your insurance company and/or check their terms if you are entitled to a compensation. After paying you can use your invoice to send to the insurance company.