VYAKTI VIKAS KENDRA INDIA � TAMILNADU APEX BODY

							                                                   VED VIGNAN MAHA VIDYA PEETH, BANGALORE

                                                                 WEEKLY PART II COURSE
                                                     REGISTRATION FORM (please tick as applicable)
                        Please write clearly and in BLOCK LETTERS. All information in this application will be kept strictly confidential.
  Name:                                                                             Sex:               Male                Female
  Age:                   Date of Birth:                        Profession:                                           Designation:

Contact Details

  Home Address:



  Telephone:                                  Mobile:

  E-mail Id:
  Health Details                                                                       AOL Course Details

    1.         Is there is any of the health condition prevailing?                     The Art of Living Course- Part 1 Teacher:___________
              Asthama             Back Pain      Walking/ Climbing Difficulty          Place                                   Date
              High Blood Pressure            Low Blood Pressure
              Heart Problem                    Pregnancy Epilepsy                      Number of the Art of living Course – Part 2 Attended: (___)
                                                                                               Place           Month     Year      Faculty
         2.    Are you currently taking any prescribed medicine?
                 Yes             No       If Yes, please mention the details.          1.
                                                                                       2.
         3.    Have you undergone psychiatric treatment?                               3.
                   Yes           No      If Yes, please mention the details.           4.

                                                                                       Would you like to do Sahaj Samadhi Meditation in Ashram?
                                                                                                     Yes               No

  Accommodation Categories: (on sharing basis)*

       1. Triple sharing            Rs. 6000                2. Five sharing Rs. 4000                  3. Dormitory      Rs. 3000
  *(In case non- availability, booking will be done in next available category)


         Payment Details: (Demand Draft in the name of “Ved Vignan Mahavidya Peeth” payable at Bangalore)

         Amount Rs. _____________________________ in Demand Draft only
         Demand Draft No._________________Dated_____________Drawn On_________________
         Note: 1. The contribution is non-Transferable and non-Refundable under any circumstances.
                2. The participant must be 21 years of age and have completed The Art of Living Course Part 1.

         Declaration

         The techniques and processes taught on advanced Meditation Course are powerful and effective when learned under the personal guidance of
         a trained teacher in the environment of the Course. These are offered to Course participants for their own personal development and only under
         the strict personal supervision and guidance of His Holiness Sri Sri Ravishankar or his trained teachers while on the Courses. They are
         confidential and are to be used by Course Participants only. By signing this Agreement below it is hereby agreed by the Course Participant and
         The Art of Living Foundation that theses techniques and processes are private in nature and will not be practiced or taught outside the
         environment of Advanced Meditation Course without the written permission of The Art of Living Foundation .

         Category-_________
                                                                                                            Signature & Date



         FOR OFFICE USE ONLY                             JAI GURUDEV

         Acknowledgement for “ADVANCED MEDITATION COURSE”                                Category-__________

         Received from_____________________________________ a sum of Rs. ___________________

         By Demand Draft No.__________________Dated ______________ Drawn on ________________

         Please Note – It is recommended to carry loose comfortable clothes, torch, mosquito repellant, water bottle and bed sheet.


                                                                                                             Arrival Date –
         ________________                     Date___________                                                Departure Date –
            Received by