Yoga for Pelvic Wellness Demonstration Class for Health & Wellness Professionals

Registration Form

Space is limited & this event is intended for providers who serve female clients/patients with pelvic floor health concerns (cueing will be specific to female anatomy). Your personal information will be kept confidential as required by law. Thank you for your interest!

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* 1. Please complete your contact information:

Name

Company

City/Town

Email Address

Phone Number

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* 2. Your occupation

Physiotherapist

Physician

Nurse/Nurse Practitioner

Midwife/Doula

Massage Therapist

Personal Trainer

Other (please specify)

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* 3. Please include me in Kathleen’s mailing list for upcoming events

Yes

I wish to receive information related to pelvic health only

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* 4. How did you hear about this event?

Direct mail or email

Colleague

Social media

Other (please specify)

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* 5. Have you practiced yoga before?

Yes

Comment:

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* 6. Do you have any of the following health concerns? Modifications can be offered for health conditions that are disclosed at registration.

Neck, Back or Spine Injury (please detail in comments section)

Joint injury (please detail in comments section)

Pregnancy

Other health conditions e.g. arthritis, osteoporosis

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* 7. What do you hope to get out of this yoga class? Feel free to mention any aspects of a yoga class that could be triggering for you.

Thank you for registering! Kathleen will contact you with any questions & you will receive a reminder one week in advance of the event. In the meantime, please review the Frequently Asked Questions & mark your calendar for Thursday February 6, 2020!