Cohort 4 -- 5 days (Mon,Tue,Wed,Thur,Fri) -- 7:00pm to 8:00pm Subscription

Please enter information on the form below to process subscription for Cohort 4 -- 5 days (Mon,Tue,Wed,Thur,Fri) -- 7:00pm to 8:00pm.

First Name *

Last Name *

Organization

Address *

Address2

City *

Zip *

Country *

State *

Phone *

Fax

Email *

Comment

Click on the link below for the Payment Instructions to pay by Credit / Debit Card via Paypal Interface

Payment Instructions

Click on the link below to view the Yoga Class Liability Waiver. Check the Check box after reading.

Liability Waiver *

Dwarkamai Yoga Classes Liability Waiver

Payment Terms

$1.67 for the first day
Then $50.00 for each month

Trial Duration Price

Trial Duration Discount

Trial Tax Amount

Trial payment fee

Gross Trial Duration Price

Regular subscription price

Regular subscription discount amount

Regular subscription tax

Payment Fee

Regular gross amount

Payment Method

Paypal / Credit Card / Debit Card : : (All through Paypal Interface)

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*