Personal Information

Desired LYT Program Session(Required)

Name(Required)

First Last Spiritual/Preffered Name

Email(Required)

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Age(Required)

Please enter a number from 18 to 100.

Gender(Required)

Is this your first visit to Yogaville?(Required)

Has someone referred you?(Required)

They may receive a special discounted Guest Stay. Restrictions apply.
For more information email lyts@yogaville.org

Referrer's Information

Referrer's Name(Required)

First Last

Referrer's Email(Required)

Referrer's Phone(Required)

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Background

Have you lived in any other spiritual community?(Required)

What other spiritual community have you lived in and when?(Required)

Hatha Yoga Level(Required)

Meditation Level(Required)

Please relate any relevant facts regarding your spiritual search and practices that may assist us in knowing you better(Required)

Why do you want to participate in this program?(Required)

Have you previously completed the LYT program?(Required)

Are you currently an IYTA member?(Required)

Health Information

Do you snore?(Required)

Do you take any prescription medication?(Required)

Please list the drug names and conditions for which you are taking them as well as dosage and how long you have been taking them.(Required)

Drug Name

Condition

Dosage

How long have you been taking this drug?

Click the + icon to the right to add additional items

Medication Agreement(Required)

I agree to bring enough medication for my entire stay and to continue the prescribed medication regimen, without alteration, during my entire stay.

Do you drink alcohol?(Required)

How often do you drink alchohol?(Required)

Do you smoke/vape?(Required)

How often do you smoke/vape?(Required)

Have you ever abused alcohol or any other drugs?(Required)

Please provide the details of the alchohol or other drug abuse, including the last date of usage(Required)

Do you have any chronic illness or physical and/or mental conditions including back problems, allergies, etc.?(Required)

Please describe your chronic illness or physical and/or mental conditions(Required)

Have you been hospitalized for any reason in the last year?(Required)

Please share details of the hospitalization including dates and details(Required)

Have you ever been arrested?(Required)

Please provide details of the arrest(Required)

Have you ever been convicted of a felony or misdemeanor?(Required)

Please provide details of the conviction(Required)

References

Can a senior member of an Integral Yoga Institute or Satchidananda Ashram refer you?(Required)

Senior Integral Yoga Member Information

Senior Integral Yoga Member Name(Required)

First Last

Senior Integral Yoga Member Phone(Required)

Senior Integral Yoga Member Email(Required)

Personal References

References should know you for at least a year;
Please exclude immediate family members.
Please notify your references that we will be contacting them shortly by phone or by email

Personal Reference 1 Name(Required)

First Last

Personal Reference 1 Phone(Required)

Personal Reference 1 Email(Required)

Personal Reference 2 Name(Required)

First Last

Personal Reference 2 Phone(Required)

Personal Reference 2 Email(Required)

[TEST] LYT Application

Personal Information

Referrer's Information

Emergency Contact Information

Background

Health Information

References

Senior Integral Yoga Member Information

Personal References

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