Address of Business/Studio/Centre:
Owner of the business must:
Name of business owner:
Certification Level: Certification LevelLevel 1Level 2Level 3Level 4
Business Website Address:
Personal Email address:
*Are you a current CIYT in good standing?
Are all teachers at the business CIYTs in good standing?
Is Iyengar Yoga the only method taught at this business?
*In good standing means that all Membership Dues and Certification Mark fees are up to date.
List the Names and Certificate Levels of Teachers teaching at the Facility
A copy of this form will automatically be sent to the IYAC/ACYI President ( firstname.lastname@example.org) and to the Membership Chair ( email@example.com)
Once the request is approved, you shall receive a signed copy via email.
Agreement with Business Owner
I, , acknowledge the above information to be accurate and truthful.
Date: July 1, 2022
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Request Iyengar Name for Business
Agree & Sign