Name

First Name

Last Name

Phone

(###)

###

####

What makes you qualify for a discounted membership?

Teacher or Student

Senior (55 and older)

Military

First Responder

Do you currently have an active membership at Yoga Room Hawaii?

Yes

Please answer the following questions:

1. What is the best way to reach you and what time of day is best? 2. Ideally, when do you want your membership to begin? 3. Do you have an ID to confirm you are eligible for the discounted rate?