Joschi Yoga NYC

Workshop Registration

Please complete this form online or print it out
and fax it to 212. 627.2251

Please register me for: Yoga4Men Beginner Series - March 07, 14 & 21

Personal Information

Name:
Date of Birth:
Address:
Address line2:
City:
State:
Country:
Zip/Postal Code:
Phone Number:
Email Address:
Emergency Contact Name:
Emergency Contact Phone:
Credit Card Information
Credit Card Type:	Mastercard Visa
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Credit Card Number:
Expiration Date:	Month 01 02 03 04 05 06 07 08 09 10 11 12   Year 2010 2011 2012 2013 2014 2015 2016 2017 2018
Billing Address:
By clicking YES below I authorize Joschi International, Inc. to initiate credit card debit entries for workshop payment. I further understand and agree that the payment is non-refundable and workshops are not transferable or exchangeable to other dates. Please give at least 48 hours notice if you need to cancel the scheduled workshop to avoid being charged.
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