IYT Home Study Registration
To register online by credit card, fill out this form and click Submit. To register by check, print this registration form and send with your payment to the mailing address below.
Optional Middle Name
 First Name
Last Name
 Address
 City
 State
Zip
 Day Phone
Evening Phone
*Provide a valid email address and you will receive a copy of this form as confirmation that your registration has been submitted:
Please enter "PYT" in this box if you are also registering for the Professional Yoga Therapist Program:
 Comments
Tuition: $475 (includes on line manual, support, and evaluation)
Visa
Mastercard
American Express
Discover
CVV (3 digit code on back of card
(4 digit code on front for Amer Exress)
 Credit  Card #
Exp.date
Amount:
• To finish your credit card registration online, click submit.
To pay by check, print this registration form and send by mail with your payment.
Integrative Yoga Therapy
1161 East Marion St #179
Shelby NC 28150
(800) 750-9642 / (415) 670-9642

www.iytyogatherapy.com
e-mail: info@iytyogatherapy.com