Eldorado Mountain Yoga Ashram
Program Application Form
Please Print this
Form or copy for
email. Form must accompany all registrations. Please print
clearly.
Date:
Name:
Phone:
Email:
Fax #:
Address:
City:_____________________ State: _______ Zip Code:______________
Program/Class/Workshop:
Cost:
Start Date
Payment Information:
Visa_____ MC_____
Credit Card #:
3-digit credit card pin:
Exp. Date:
Name on credit card:
Or:
Check #:
Driver’s License #:
Make all checks to S.G.R.Y.
Mail or Fax application with payment to:
Eldorado Mountain Yoga Ashram
P.O. Box 307
Eldorado Springs, CO 80025
Fax # 303-494-3051
For
Eldorado Staff
Date received:
Received by:
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