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Name

Phone

Home Address

Email

Emergency Contact Name and Phone Number

Occupation

Are you a certified yoga instructor? How long have you been practicing yoga? How often do you practice yoga? how do you plan to use this training?

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I release Marsha T Danzig from any liability now, or in the future for injury occurring during or after participation in this training. It is solely my responsibility to monitor each activity and determine whether it is appropriate to participate. I remain responsible for my safety and well-being. All material in this training is copyrighted and cannot be taught or copied without the express written permission of Marsha T Danzig. No person may train others in Yoga for Amputees without the express permission of Marsha T Danzig, Founder and CEO of Y4A: Yoga for Amputees by Marsha T Danzig.

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