Integral Yoga Center Application Name* First Spiritual/Preferred Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneWork PhoneCenter PhoneFaxEmail* Website OccupationGender* Male Female Marital Status* Single Married Skills & Hobbies*Please indicate which Hatha Teacher Trainings you have takenPlease check all IY Hatha Teacher Trainings you have taken* Basic TT Intermediate TT Advanced TT Others How many Other Teacher Trainings have you taken?Please enter a number from 0 to 6.Other TT #1 TT Name Date Location Principal Trainer Other TT #2 TT Name Date Location Principal Trainer Other TT #3 TT Name Date Location Principal Trainer Other TT #4 TT Name Date Location Principal Trainer Other TT #5 TT Name Date Location Principal Trainer Other TT #6 TT Name Date Location Principal Trainer Essay QuestionsHow long have you been practicing asanas and pranayama?*Do you have a regular meditation practice?* Yes No If yes, please describe your meditation practice.How long have you been associated with Integral Yoga?*When did you take Integral Yoga mantra initiation? MM slash DD slash YYYY Who officiated your mantra initiation?Some other educational programs have you taken which would be useful in your role as center director? (optional)Some other spiritual programs and retreats have you taken? When and Where? (optional)Why do you want to establish an Integral Yoga Center?*ReferencesPlease give the names of two senior disciples of Integral Yoga who can recommend you to serve as the head of an Integral Yoga CenterName* First Last Phone*Email* Name* First Last Phone*Email* AgreementI have read the Integral Yoga® Centers Statement of Purpose, Policies and Guidelines, and fully understand the purposes and functions of the Integral Yoga® Centers, as well as the policies and guidelines by which they are run. If granted the privilege of establishing an Integral Yoga® Center, I will try my best to live a life in accordance with those principles. I will include all possible Yoga practices in my daily life as I strive toward perfection in the precepts of Integral Yoga,® such as truth, non-violence, spirit of dedication and universal brotherhood. I will offer my services to further the growth of the Center, providing instruction in the teachings of Integral Yoga according to the methods and standards of the IYI. I agree to tithe 3–10 percent of my annual profits to Satchidananda Ashram—Yogaville.Signature*Use your finger or mouse to signApplication Fee: $108 ($54 refundable if not accepted)Payment Method* Credit Card Check Other Credit CardCard Details Cardholder Name Make check for $108 payable to "IYTA" . and mail to: IYTA 108 Yogaville Way Buckingham VA 23921Please contact IYTA to arrange for other payment types Dub VanDina 434 969 3121 x 162 [email protected]Application Fee total* Price: u Questions? Contact: 434 969 3121 x 159 [email protected]
