PranayamRX Training Application ENERGIZE (Module 2)*UNWIND (Module 1) is a pre-requisite* Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Current Employment/Occupation * Educational Background * How did you hear about us? * Why are you applying for this training? * Want to begin a breathing practice Want to deepen my breathing practice Want to help someone breathe better Want to learn breathing techniques to add to my offerings Want to become a certified breath teacher Other If approved, what payment plan are you considering? * Module 2 - $1299 (Full Payment) Module 2 - 2 payments of $660 (Payment Plan) I'd like to schedule a time to speak with a trainer Module 1 is a prerequisite for Modules 2 and 3, and to receive certification. * Have you completed Module 1? Yes Thank you!