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Yoga Awareness
USA, Hawaii, Japan, India

YOGA AWARENESS
'REFER A FRIEND'
15% REWARD CREDITS

Refer a friend 'who is new to us' and they are tagged to you for life ! You don't need to do anything. On registration a new student is automatically assigned a tag. But please let us know in advance when you refer someone so that they become tagged to you. If your friend takes any Yoga Awareness trainings then we give you a 15% credit as appreciation for your referral. This referral credit will be deposited into your Yoga Awareness account which you can use anytime for your own personal Yoga and Ayurveda needs, view more >>

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Date
First Name
Last Name
Race / Heritage
Gender
Birth Date
Age
Height
Please select
Body Weight
Please select pounds kilograms

Birth Place
Current Living Place
From Year
To Year

Parents
No. of Brothers
No. of Sisters
Are you the eldest, youngest, etc?
Marital Status
For how long?
No. of Children
Ages

Education
Work (describe) + (hours per day) ?
Leisure (describe) + (hours per day) ?
Exercise (describe) + (hours per day) ?
Hobbies
Yoga personal practice:
Yoga (self) - no. of years have you been practicing ? none 0 - 1 1 - 5 5 - 15 15 +
Yoga (self) - no. of times you practice per week ? none 1 2 3 4 5 6 7
Yoga Style / Description
Yoga Teaching:
Yoga (work) - no. of years have you been teaching ? none 0 - 1 1 - 5 5 - 15 15 +
Yoga (work) - no. of times you teach per week ? none 1 2 3 4 5 6 7
Ayurveda personal practice:
Ayurveda (self) - no. of years have you been practicing ? none 0 - 1 1 - 5 5 - 15 15 +
Ayurveda (self) - no. of times you practice per week ? none 1 2 3 4 5 6 7
Ayurveda professional:
Ayurveda (work) - no. of years working in professional care ? none 0 - 1 1 - 5 5 - 15 15 +
Ayurveda (work) - no. of times you work per week ? none 1 2 3 4 5 6 7
Personal Medical Information:
What is your current Health condition ?
Are you receiving any Healing Treatments ?
Are you taking any Supplements or Medication ?
Do you have any previous Medical History ?

Color Photo - Head View (jpg)

Color Photo - Full Body View (jpg)
When you submit this Self History Profile information it is confidential and sent only to Tedd Surman, Yoga Awareness.
Your Email:

Self History Profile - Wellness

Please complete the form below and submit.

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