Yoga Registration & Payment 2016-2017

Onsite Yoga Classes

Use this form to register and indicate payment option for onsite yoga classes.

Class times are as follows:

Tuesday's at 4:30 PM

Thursday's at 4:30 PM

Classes are held in Marley Education Center (Room 218 or 219)

Participants may attend one class per week (to be mindful of the limited room space available)

Here are details about the program:

Classes are offered in 6-week series
Participants must enroll in the 6-week series to participate (ex: cannot enroll for a single class)
When you register, you will pay up front for a minimum of 6 classes (cost is $6 per class)
Class size is limited, so after you register you will be notified if you are able to join the next 6-week series and of your start date, if applicable (which will be the first class of the next series)

Question Title

* 1. Participant Information

First Name:

Last Name:

Crouse #:

Email address:

Cell Phone # (only used if needed, ex: last minute class cancellation for weather):

Question Title

* 2. Select your organization

Other (please specify)

Question Title

* 3. Select your "PRIMARY" class, which will be the one you plan to attend MOST FREQUENTLY (you are able to go to different classes if you need to on any given week):

Tuesday at 4:30pm

Tuesday at 6:00pm

Thursday at 4:30pm

Question Title

* 4. Your Preferred Payment Option
You must complete the payroll authorization below or bring cash/check to the Employee Health Office (8 Memorial). When you receive your confirmation email, you will be notified of your payment due date (two weeks prior to start of the series).

Crouse Hospital or CMP Employee Payroll Deduction (this form is the online payroll deduction)

Cash or Check made payable to Crouse Hospital (deliver to the Crouse Hospital Employee Health Office on 8 Memorial)

Participants using CASH/CHECK and wish to enroll in the next 6-week series will be required to submit payment by Week 4 of the current series.

For example, for the series beginning on December 13, 2016 - you must submit payment by November 22, 2016 to continue the program (otherwise your spot will be offered to other participants on the waiting list).

Question Title

* 1. Participant Information

Question Title

* 2. Select your organization

Question Title

* 3. Select your "PRIMARY" class, which will be the one you plan to attend MOST FREQUENTLY (you are able to go to different classes if you need to on any given week):

Question Title

* 4. Your Preferred Payment OptionYou must complete the payroll authorization below or bring cash/check to the Employee Health Office (8 Memorial). When you receive your confirmation email, you will be notified of your payment due date (two weeks prior to start of the series).

* 4. Your Preferred Payment Option
You must complete the payroll authorization below or bring cash/check to the Employee Health Office (8 Memorial). When you receive your confirmation email, you will be notified of your payment due date (two weeks prior to start of the series).