Prem Nirmal Holistic Form


HOLISTIC CHAKRA LIFESTYLE WORKSHOP: REGISTRATION FORM
Full Name:
Phone No. / Mobile:
Resi.:
Educational Qualifications:
Specialization, if any:
Your Profession:
Designation:
Address for Communication:
e-mail ID:
Please write here the programs you have attended for self-growth & well-being:
Are you practicing any type of spiritual process / kriya / Meditation for your spiritual growth? Please write the details here:
If you have any health related Problems, Please mention here:
Total Amount to be Paid: ( Rs.3000/-) Investment in Learning: Rs.3000/-
Payment by cash or Cheque / DD drawn in favour of “Tao Anand Spiritual Centre” payable at Mumbai. Payment by cash or Cheque / DD to be couriered to Mr. Prem Nirmal, 133, Shanti Ind. Estate, Sarojani Naidu Road, Mulund (W) Mumbai -400080
Declaration & Release form: I here by declare that I wish to join Holistic Lifestyle workshop at my will. I will follow the instructions for my own growth. I assure that my behavior during workshop will be conducive to learning and will not create any hindrance in other participants learning. I take my own responsibility and release all other (including organizer, facilitator and fellow participants) for any consequences whatsoever.
Place:
Date:

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