8/11/2019 Kolkata RegForm

1/1Shiv Yog Advance Prati Prasav Sadhana Kolk

Service Tax No. AAJFG9307KSD001DD need to be made in favor of GEETAParticipation Fee comprising Basic Fee:_ DD N o. ________ Bank _________ D

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Form No.: __________________

Name:______________________

Registration done by: _________

ADVA

AP

Name (First Middle Surname):

Date of Birth:

Mobile No. :

Marital Status:

Address for Communication:

City:

State:

Highest Qualification:

SHIVYOG SHIVIR DESCRIPTION

Shree Durga Saptashati Shivir

Siddha Healing & Shambhavi Dhyan

Advait Shree Vidya Level I

Advait Shree Vidya Level II

Advait Shree Vidya Level III

Infinite Dimesional Advait Shree Vidya

Prati Prasav / Adv Prati Prasav Sadhna

Art of Self Realisation / Art of Dying

I am participating in the SHIVYOG programwhatsoever. I wi l l maintain the sanctity of t

disc ipl ine during the program and I understapremises and I wi ll be refused admission itr ans fe ra ble. Us e o f MO BI LE PH ON ES i s no t p eprogram. Recording of the program contea sk ed t o l ea ve th e v en ue an d h is re gi st ra

I conf irm that al l the information is t

Signature of Applicant

ata 2014

REGISTRATION

NJALI YOG LLP , payab le at New Delh i

_______, Service Tax: _________, Total Participationated: ____________

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Date:________________________ __ Receipt No.:

__________________ Donation Amount:_______

__________________ Signature:_____________

NCE PRATI PRASAV SADHANA

PLICANTS PERSONAL INFORMATION

Gender: Male Female

Email ID:

PAN:

ZIP:

Country:

Profession: Profession

Shiv Yog Shivirs Attended

Place / City Name

(Where you attended

this shivir first time)

Month & Year(When you attended this

shivir first time)

DECLARATION

at my own wi l l. I take fu l l responsibil i ty for part ic ipating in the program and keep the proceed ing o f the program con fi de

nd that if my conduct is found to be inappropriate, I wouldn the program. The participation fee for the program is nrmitted inside the venue, you are advised to not to carry it witt b y a ny d ev ic e o r m od e i s st ri ct ly p ro hi bi te d. A ny on e fion will be cancelled.

rue to the best of my knowledge.

Place Date

ee: _________

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_____________

______________

_____________

Please Paste yourrecent Passport size

Photograph here.

al Specialization:

No. of times(You attended this

type of shivir)

i s program, i ts outcome tial. I wil l maintain the

be asked to vacate the on-refundable and non-

you while attending the und recording will be

Kolkata-2014

(6th - 10thAug)