First Name: (required)
Last Name:
Birthdate:
Occupation:
Annual income:
Can you provide proof of income? (If so please attach to the application)Max upload file size: 5MB
Do you have dependents? If so how many:
Which of the following are most interested in? (highlight, circle, or bold those that apply): Sliding Scale Drop InsSliding Scale Membership
How often do you plan on practicing at Union Yoga? (highlight, circle, or bold those that apply): Sunday 9am, 1030am, 530pmMonday 6am, 730am, 9am, 4pm, 530pm, 7pmTuesday 730am, 9am, 1030am, 4pm, 530pm, 7pmWednesday 6am, 730am, 9am, 4pm, 530pm, 7pmThursday 730am, 9am, 1030am, 4pm, 530pm, 7pmFriday 9am, 1030am, 530pmSaturday 9am, 1030am
Email (required)
Phone Number(required)
What are you recovering from? (highlight, circle, or bold those that apply): Eating DisorderAlcoholism
