Name

First Name

Last Name

What is the name of your organization?

Email

Phone

(###)

###

####

What service are you interested in?

Please check all that apply.

YOGA CLASSES

MEDITATION CLASSES

BOTH

Is this a one-off event, or a need for recurring programming?

Single Event

Recurring Program

Describe your clientele.

Please use as much detail as possible including special needs or accommodations.

What are you looking for with this event or continuing program?

(i.e: specific needs you are looking to address with yoga/meditation).

Are you able to pay for services?

Yes

Yes, but only a portion

No, I require pro bono service

Outreach Department