Yoga Class Registration Form
Adult / Family / Children's YogaKids

Please print and mail to:
Valerie DeWitt / Yoga Class Registration
7170 SW 116th Terrace
Pinecrest, FL  33156

Checks payable to Valerie DeWitt

Name of Student(s) _______________________________________
Check submitted by _______________________________________
Address _____________________________________________________
City  __________________ State ________________ Zip _________________
Home Phone  ________________   Work Phone ________________________
E-Mail _______________________________________________________


Class Location:
The Yoga Institute ________________  Month 
Temple Bet Shira  ________________  Month
Specify Class:
______  Adult ______  Family _______ YogaKids

Registration date received ________________ (for office use only)

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