Registration – Eye Care & Shanmukhi Mudra

Please fill in the registration form and answer the questions below to confirm participation. The completed form with personal data will be treated confidentially.

Select program dates:

Personal information:

First Name:
Family Name:
Your Email:
Contact number:
Please describe briefly your current health condition:

Please describe briefly if there are any yoga practices you are doing regularly:

For security reason please answer the following question:

You will be directed to PayPal page to complete the payment. In case you don't have a Paypal account, once the next page opens, DO NOT close the window. Instead, click on the link at the bottom "Cancel and return to Ascendance" on the PayPal page. You will be re-directed to online payment information.


Venue

Location: Heesterakker 2, 5281 LV, Boxtel.  We are at the top floor of the building. The hall is open for entry 30 minutes before the program starts.