IMPORTANT APPLICATION INFORMATION—PLEASE READ FIRST:

Applications for The Personal Revolution Beginner & All Levels Bootcamp are individually reviewed. We accept last minute applications if there is space in the program. Submission of your application indicates that you have read, understand, and agree to all of the requirements for the Bootcamp. Once you submit your application, please email a color photo to programs@baronbaptiste.com or send it to BPYI, P.O. Box 400279, Cambridge, MA 02140. Once your application is complete you will hear back from BPYI within 2 weeks. If you have not heard from us after 2 weeks, please call us at 617-441-2144. Photographs are used for administrative purposes only. On your photograph please include your full name, location, and dates of the program you are applying for.

Upon acceptance to the program, we will charge your credit card the non-refundable, non-transferable deposit amount and send you a second electronic notification to confirm your acceptance. For those paying by check, please send a check for the $500 non-refundable, non-transferable deposit upon submitting your application. Your application will not be processed without the check. Your check will not be deposited until you are accepted. If you are not accepted to the program, your check will be returned to you. Please note: applications will not be reviewed without a colored photo and a deposit.

• Deposit is charged upon acceptance. NO EXCEPTIONS. The deposit is nontransferable/nonrefundable.
• Housing selections must be made within 2 weeks of acceptance.
• Final payment information is made at time of Housing selection.
• Full tuition is due 6 weeks prior or you risk losing your space.
• Tuition is nonrefundable, nontransferable 6 weeks prior.
• We reserve the right to cancel a program at any time.
• Please review our cancellation policy

I have read and understand the above terms and requirements.
Yes  (required)

Please choose only ONE program:

	The Personal Revolution Beginner & All Levels Bootcamp, with Baron Baptiste, Mexico, October 24 - October 31, 2009.
	The GREAT Assisting Program and Personal Revolution Bootcamp with Baron Baptiste, for Level 1 and/or Level 2 graduates, October 24 - October 31, 2009.
	I am attending BOTH Level 1 Teacher Training Bootcamp and Personal Revolution Beginner & All Levels Bootcamp, with Baron Baptiste, Mexico, October 17 - October 31, 2009.
	I am attending the GREAT Assisting Program and BOTH Level 1 Teacher Training Bootcamp and Personal Revolution Beginner & All Levels Bootcamp, with Baron Baptiste, Mexico, October 17 - October 31, 2009.

First Name:
Last Name:
Street Address:
City:
State:
Zipcode:
Country:
Daytime Phone:
Evening Phone:
E-Mail:
Emergency contact:
Name:
Phone:
Where did you hear about our program?
Have you attended any Baptiste programs before? Yes  No
If so, please list the program year(s) and location(s) here:
Do you currently practice yoga at a Baptiste-affiliated studio? Yes  No
If so, please list the studio name(s) and location(s) here:
Please tell us about yourself
Age:
Gender: Male Female
Marital Status:
Job Title:
Company:
Physical Health Please note that this section of the application is mandatory and that you will not be accepted without filling in these required fields accurately and honestly. How would you evaluate your current health? Excellent Good Fair Some Challenge
Are you currently, or during the last two years have you been under the care of a physician or other health care professional?
Yes No
If Yes, for what reason?
Do you have epilepsy?
Yes No
Do you have diabetes?
Yes No
List the health care professional's name, specialty and address:
Name:
Specialty:
Address:
Please list any medications you are currently taking or have taken in the last year that were prescribed by a health care professional:
Are you currently, or during the last two years have you been, under the care or supervision of a mental health professional(psychiatrist, therapist, etc.)?
Yes No
If yes, for what condition?
Please list the mental health professional's name, specialty and address:
Name:
Specialty:
Address:
Please list any medications you are currently taking that were prescribed to you by a mental health professional:
Have you been hospitalized in the past year?
Yes No
If yes, for what condition?:
Do you have any special dietary requirements? If yes, please list:
Do you have any challenges in participating in any physical activities?
Yes No
If yes, please list:
Do you smoke?
Yes No
Do you drink alcohol?
Yes No
If yes, how much and how often?
Do you use drugs?
Yes No
If yes, how much and how often?
PAST HISTORY WITH YOGA PRACTICE:
Baptiste Bootcamps/retreats/workshops attended (please indicate month & year you attended):
Program attended:
Month:Year:
Please list any related yoga courses or retreats that you already have completed (other than Baptiste Programs)
Please list any NON-yoga personal growth, transformational based courses, workshops, seminars or retreats that you already have completed (other than Baptiste Programs)
Have you already participated in this bootcamp/teacher training in the past? Yes  No
If yes, when?
For the purpose of this program we need you to let us know whether you are a beginner or experienced student. You will be allowed to participate in either/both sessions during the week. You are considered a beginner if you have had less than one year of experience. To consider yourself an experienced practitioner for this program, you must have one year minimum continuous study and practice of yoga with a working knowledge of the Baptiste Power Vinyasa Yoga Sequencing foundin Baron's book Journey Into Power, and be able to do Urdhva Dhanurasana (Wheel pose) with straight arms, pushing up from the floor without assistance.
Please Select: Beginner Experienced
PERSONAL ASSESSMENT: What is your purpose for attending this program?
In the following section list three important and specific outcomes that you desire for your personal life and why they are important.
Personal
1.
Why?
2.
Why?
3.
Why?
What are your desired outcomes for attending this Bootcamp program?
How can we best support you in achieving your outcomes?
Please write a sentence or two about the following areas of your life. What would you most like to improve in each area?
PHYSICAL:
What would I like to improve?
EMOTIONAL:
What would I like to improve?
SPIRITUAL:
What would I like to improve?
Of the 3 areas, what is the area in which you are the weakest? Why? What will it take for you to have a change in this part of your life?
GREAT ASSISTING PROGRAM QUESTIONNAIRE: If you are applying to the GREAT Assisting Program, please answer the following questions. The cost of participating is $350 in addition to your total cost for Bootcamp.
Which previous Level 1 or Level 2 programs did you attend? (please indicate month/year and location):
Program: Month:Year: Location:
Program: Month:Year: Location:
Do you teach yoga?
Yes No
Describe your teaching schedule and class structure:
Do you assist?
Yes No
What are your goals for attending this program?
PAYMENT METHOD: Please Select Here ------------------------------ Visa Credit Card Mastercard Credit Card American Express Credit Card Mailing Payment

	Name on Card: Card Number: Expiration Month: Select A Month ------------------- January February March April May June July August September October November December Expiration Year: Select A Year ------------------- 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Questions? Phone: 617-441-2144