------------------------------------------------------------------------------------------------------------------

Name:_______________________________________________________________________________

Address:______________________________________________________________________________

Phone: Home:_____________________  Work: _____________________   Cell: ____________________

I am registering for the CIRCLE ONE class, in the Studio / on Zoom. CIRCLE ONE
Tuesday 10:00 a.m. / Tuesday 5:30 p.m. /
Thursday 10 a.m. / Thursday 7:00 p.m. / Saturday 10:00 a.m.

The second or third class that I desire to take is CIRCLE ONE OR TWO.
Tuesday 10:00 a.m. / Tuesday 5:30 p.m. / Thursday 10 a.m. /
Thursday 7:00 p.m. / Saturday 10:00 a.m., on Zoom.

PLEASE MAKE CHECKS PAYABLE TO HILLARY BLACKTON.
-------------------------------------------------------------------------------------------------------------------

Print this page and return the form with your check:
Hillary Blackton
Divine Life Yoga
19008 High Point Drive
Gaithersburg, MD 20879-3402

Call Hillary Blackton at 301-924-5164 or email hillary@divinelifeyoga.com if you have any questions.

Return to the Divine Life Yoga Web Site