Healing Yoga Foundation Class Payment

Contact Information

First Name

Last Name

Email Type

PersonalWork

Payment

Payment Amount: $

Please enter numbers only

Class format:

In-personVirtual

Please provide information about what this payment is for:

Please specify the dates, length of sessions and purpose (yoga philosophy/yoga therapy/something else). For example: 5.31.23, 90 minutes yoga therapy + 6.14.23, 60 minutes yoga therapy.

Credit Card Information

Name on Card

Cardholder Address

Cardholder City

Cardholder State

Cardholder Province

Country

Cardholder Zip/Postal Code

Card Number

Expiration Month (##)

Expiration Year (##)

CVV (###)