Neti Advisor Enrollment Form

If you are interested in helping people seeking to learn Neti in your city then, please spare a moment to fill the following form.

Contact Details

Would you like your contact # to be passed to the customer / prospective student in your area seeking this specific service Yes No

Name :

Street Address :

City :

State / Province :

Zip/ Postal Code :

Phone :

Your e-Mail ID :

Any preferable time to
Contact :

DETAILS RELATING TO NETI SERVICE

Stages of Neti that you are comfortable to instruct: (check relevant boxes)

	Stage 1 (water in - one nostril; water out - other nostril)
	Stage 2 (water in - nostril; water out - mouth)
	Stage 3 (water in - mouth; water out - nostril)

Experience of doing Neti:

Less than 1 year

More than 1 year

Would you also like to offer sale of Neti pots to your students?

	Yes No
		If yes, please enter charges desired: