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Questions marked with a * are required
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Contact Information
First Name
*
:
Last Name
*
:
Address 1
*
:
Address 2 :
City
*
:
State
*
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
Zip
*
:
Phone
*
:
Email Address
*
:
Are you 18 years old or older? (If you are younger than 18 you will not be allowed to practice Tantric Yoga for Men.)
Yes
No
I am:
Gay
Bisexual
Straight
Single
In a gay relationship
In a straight relationship
How would you characterize your physical state of health?
Excellent
Average
Poor
Indicate any health concerns we should be aware of. If none, write "none".
Do you work out or have a fitness program?
Yes
No
What type of workout or fitness program?
Why are you interested in practicing naked yoga with others like yourself?
Have you ever participated in any of the Body Electric workshops?
Yes
No
If you have practiced or practice yoga, what style?
I have not practiced yoga
Hatha
Iyengar
Bikram (Hot Yoga)
Kundalini
Pratyaahvaya (at the Stress Management & Prevention Clinic)
Other
On the average, how many times per week do you practice yoga?
I do not practice yoga
Less than once a week
Once a week
Twice a week
More than twice a week
Would you be comfortable with a man touching you non-sensually?
Yes
No
Would you be comfortable with a man touching you sensually?
Yes
No
What are the best times for you to come to practice yoga?
Early in the morning (before 8:00 a.m.)
Around noon
In the evenings
On weekends
Would you be interested in attending naked yoga and meditation retreats?
Yes
No
If interested in attending naked yoga and meditation retreats, would you attend retreats in...?
(Check all that apply.)
In the Palm Springs, California area
Elsewhere in California
Other states in the US or Canada
Other countries besides the US and Canada
How did you find out about us? (Check all that apply.)
Web search
Craig's list
Word of mouth
Ad in Bottom Line
Ad in Desert Daily Guide
Gay Yellow Pages
Other
Please contact
casellas@ccscientific.com
if you have any questions regarding this survey.
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