300-Hour Application Fill out the form to apply to one or more modules of the Radiant Body Yoga (RBY) 300-Hour advanced training program.1 Contact Information2 History3 Teaching Experience4 Essay Questions5 Essay Questions Continued6 Health Information7 PaymentToday's Date* Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Please check each module you are applying for. You will be charged a $200 deposit per module at the end of the form.* Prana & Pranayama Mantra and the Yoga of Sound Meditation and the Mind Kriya, Flow, and the Art of Teaching Awareness & Lifestyle How many years have you been practicing yoga?*I'm new to yoga2-5 years5-10 years10+ yearsWhat style(s) or lineage(s) of yoga have you practiced?*Have you practiced with Kia before?*YesNoWhen and where have you worked with Kia before?* Are you currently teaching yoga or meditation?*YesNoHow long have you been teaching?*0-2 years3-6 years6-10 yearsMore than 10 years What do you love about the practice of yoga?*What does yoga mean to you?*Who are your top yoga influences, and why?*Do you intend to teach yoga after this training?*YesNoWhat is the inspiration behind your intention to teach?* How did you hear about the Radiant Body Yoga training?*Do you have any hesitations about this training? If so, what are they?* Do you have any medical conditions?*YesNoPlease describe any medical conditions you have*Are you taking any prescription medications?*YesNoPlease list all of your prescription medications* Prana & Pranayama: Deposit Price: $ 200.00 Mantra & the Yoga of Sound Deposit Price: $ 200.00 Meditation and the Mind Deposit Price: $ 200.00 Kriya, Flow, and the Art of Teaching Deposit Price: $ 200.00 Awareness & Lifestyle Deposit Price: $ 200.00 Total $ 0.00 Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name If for any reason your application is not approved, we will refund your payment. This iframe contains the logic required to handle Ajax powered Gravity Forms.