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* 1. Welcome and thank you for your interest in our Personal Transformation and Teacher Training Program.  We are excited to share this powerful practice and a chance of transformation with you.

Upon submission of this application it is required that your $500 deposit be made within 48 hours to hold your spot.  You will receive a welcome email within 7 days of receipt of your application and deposit

In order to successfully complete this program, you must complete all 200 hours.  Submission of this application indicates that you have read the requirements and noted the program dates as listed at www.moonshinepoweryoga.com

We are super excited to have you enroll in this life-changing journey – Here We Go!!!!!

I have read the requirements of the program and am committed 100% to the program.

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* 2. First and Last Name

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* 3. Street Address, City, State, Zip Code

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* 4. Phone Number

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* 5. Email Address

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* 6. Emergency Contact Name and Phone Number

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* 7. Why are you interested in completing the Moonshine Leadership Program?

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* 8. List below any other yoga related programs you have completed and when.

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* 9. Tell us about your current yoga practice, how long, how often and what style.

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* 10. Please list all injuries, disabilities or health concerns necessary for your safety.

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