Full Name: Phone No.: Mobile: Educational Qualification: Your Profession: Address For Communication: email 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: Declaration & Release form: I here by declare that I wish to join 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 r esponsibility and release all other (including organizer, facilitator and fellow participants) for any consequences whatsoever. place: Date:
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