REGISTRATION FORM TO AYM-ARYM TRAINING COURSES
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Then fill the questions and send it back to us.

Indicate the courses you want to register:
• Dates:
• Levels:
• Venue:
If needed, you can add more dates below:
• Dates:
• Levels:
• Venue:

Your Personal Details:
• First name:
• Last name:
• Male ( ) Female ( )
• Birthdate (DD/MM/YYYY):
• Email:
• Address:
• Zip Code:
• City:
• State:
• Country:
• Native language:
• English spoken:
• Other languages spoken:
• Website:
• Mobile:
• Phone:
• Occupation:
• Emergency contact name:
• Emergency phone number:
• Do you have any experience in Ayurvedic Yoga Massage?
• Practice of Yoga, Pilates, sports, meditation, alternative medicine and other self-development practices and studies:
• Other information you'd like to specify:


Your Health Details:
Please reply: Y or N (Yes or No); Not known; or answer the question and detail if needed
• Age:
• Height (cm):
• Weight (Kg):
• Low Blood Pressure:
• High Blood Pressure:
• Medication taken to regulate blood pressure:
• Blood Pressure (if know):
• Blood type:
• Diet type (if special):
• Briefly describe your health:
• Do you have or had any of the following conditions? Please detail and precise for how long
• Cardiac problems:
• Circularly problems:
• Respiratory problems:
• Spine problems:
• Other joint, ligament or tendon problems:
• Any pain, especially in knees, shoulders, elbows, wrists and hands?
• Digestive or food problems:
• Hormonal or skin allergies problems:
• Any other chronic problems and specific condition we should know?:
• Any surgery and accident (please detail about any remaining sequelae)?
• Treatments and prescriptions:
• Please read and verify your answers, then type the following mention: “I hereby verify that the above information is correct”
->>> Type the mention here:
• Send your registration form to contact@arym.org

Once filled, please send your registration form to contact@arym.org

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2014-Indian Institute of Ayurvedic Yoga Massage AYM-ARYM