Yoga In Bali — Asia Students Registration Form February 2018

Please choose which program for enrollment:

Program # 1
9 Day / 8 Night Package: Tuesday, 13 February - Wednesday, 21 February, 2018 (16 classes)
Option A.) - Yoga classes fees only (students arrange their own Ubud accommodations) = $600.00USD
Option B.) - Yoga classes and 8 nights shared Ubud accommodations at studio accommodations = $900.00USD.

Program #2
5 Day / 4 Night Package: Tuesday, 13 February - Wednesday, 21 February, 2018 (8 classes)
Option A.) - Yoga classes fees only (students arrange their own Ubud accommodations) = $300.00USD
Option B.) - Yoga classes and 4 nights shared Ubud accommodations at studio accommodations = $450.00USD

Program #3
5 Day / 4 Night Package: Saturday, 17 February -Wednesday, 21 February 2018 (8 classes)
Option A.) - Yoga classes fees only (students arrange their own Ubud accommodations) = $300.00USD
Option B.) - Yoga classes and 4 nights shared Ubud accommodations at studio accommodations = $450.00USD

Enclosed Enrollment Fees for: Full payment due by January 30, 2018

Program #1 = 13 - 21 February (9D / 8N)

________Option A $600.00

_______ Option B $900.00

Program #2 = 13 - 17 February (5D / 4N)

________Option A $300.00

_______ Option B $450.00

Program #3 = 17 - 21 February (5D / 4N)

________Option A $300.00

________Option B $450.00

Name __________________________________________________

Address _______________________________________________

Home phone ____________________________________________

Business Phone ________________________________________

Email Address ________________________________________

Date of Birth _________________________________________

Special Interest ______________________________________

For International students, please provide full payment via bank transfer to:

Bank of America
41st & Capitola- 4055 Capitola Rd.- Capitola, Ca. 95010 USA
Swift # BofA US3N
Routing # 026009593
Name on Account: Ann Barros
Account # 0006705-02286

email Ann at abarros@pacbell.net