Payment Confirmation *

Yes, I did make the payment.

No, I will complete the payment first and then return to submit this form.

Seats are not reserved without payment.Please complete payment before submitting this form.

First Name

Last Name

Phone *

Email *

Address

Street Address *

City *

State *

Country *

Country

Postal Code *

Age *

Gender *

Male
Female
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Emergency Contact: Full Name

Emergency Contact

Emergency Phone Number

Emergency Contact Phone Number

Select Your Workshop or Program *

Yogasanas
Angamardhana
Surya Kriya
Surya Shakti
Bhuta Shudhi
11 Days Surya Shakti
21 Days Surya Shakti
11 Days Angamardhana
21 Days Angamardhana
21 Full Sadhana Workshop
11 Days Full Sadhana Workshop
Reviewing Angamardhana
Reviewing Yogasanas
Reviewing Surya Kriya
Review Surya Shakti
Reviewing Bhuta Shuddhi
Other (mention in the box below)
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Other (mention in the box below)

Which location would you be attending the workshop ? *

New York City, NY

Hillsborough, New Jersey

Have you had any surgery in last 6 months ? *

No

Yes

Permission to Yoga Nebula to photograph, film, tape or record me as a participant in this Yoga Class. *

No

Yes

As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated *

No, I would not be attending the workshop

Yes, I agree and would be attending the workshop

If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher.I will continue to breathe normally *

No, I would not be attending the workshop

Yes, I agree and would be attending the workshop

Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions *

No, I would not be attending the workshop

Yes, I agree and would be attending the workshop

I affirm that I alone am responsible to decide whether to practice yoga. *

No, I would not be attending the workshop

Yes, I agree and would be attending the workshop

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re- education and relief of muscular tension. *

No, I would not be attending the workshop

Yes, I agree and would be attending the workshop

I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against YogaNebula or Samir Lal or it's Volunteers or Isha Foundation and its nationally registered yoga teachers *

No, I would not be attending the workshop

Yes, I agree and would be attending the workshop

Do you have or have you had any mental ailments including depression or anxiety? If yes, provide details. *

Do you have or have you had any physical ailments? If yes, provide details. *

What do you want to derive out of this workshop ? *

Please indicate below if you currently or previously have had any physical or mental ailments? *

Previous Experience & Practice History
New participants may select “Not Applicable.”
If you have learned this practice before and are returning for a refresh, please provide the relevant details.

When did you learn the practice for the first time *

More than 1yr ago

6 months ago

under 6 months

Not Applicable, I am learning this practice for the first time.

How regularly do you practice *

A few times a week

Daily

Not regularly

Not Applicable, I am learning this practice for the first time.

Have you attended review sessions before *

Yes, (provide details in the comment box below)

No

Not Applicable, I am learning this practice for the first time.

Provide details about where you learnt the practice and who was the teacher. *

share the teacher name, month & year. (enter not applicable if you are learning the practice for first time)

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