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

Name:_______________________________________________________________________________

Phone: Home:____________________  Work: ____________________   Cell: ___________________

Enclosed is my class fee for the selected class period: CIRCLE ONE
Saturday 10:00 am / Saturday 12:00 pm / Saturday 2:00 pm / Sunday 3:30 pm / Sunday 5:30 pm /
Monday 5:30 pm / Monday 7:30 pm / Tuesday 10:00 am / Tuesday 5:30 pm / Tuesday 7:30 pm /
Wednesday 5:30 pm / Wednesday 7:30 pm / Thursday 10:00 am / Thursday 7:30 pm.
-------------------------------------------------------------------------------------------------------------------

Print this page and return the form section with your payment to:

Divine Life Yoga
19008 High Point Drive
Gaithersburg, MD 20879-3402

Call Hillary Blackton at 301-924-5164 if you have any questions.