Ayurvedic Workshop Registration Form 

Name: _______________________________   Street Address: _____________________________

City: ________________________________    State: _______ Zip: __________________________

Home Phone: (____)______-_____________    Email: _____________________________________

q       Cash/Money order

q       Check No*: _______

q       Visa.

q       Master card

q       American Express

q    Discover

CC #: ___________________________ Exp Date: ___ / ___ / ___  

Signature: _____________________________________________

* Make checks payable to The Kundalini Yoga Center