Registration Form

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: