Application form for Jeevan Vidya Workshop at Dharwad, Karnataka (21

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Application form for Jeevan Vidya Workshop at Dharwad, Karnataka (21 - 28 March 2020)

Please note that the workshop is in the nature of an intensive immersive retreat that has to be attended in its entirety. It may not be attended partially. Participants are expected to arrive by the evening of 20th March, and may leave after lunch on the 28th of March, 2020.
This form is an application for individual participation only.
(The workshop is for individual participation only. DO NOT plan on attending the workshop with your family / friends / spouse / partner etc.)
You should consider yourself duly registered only after you receive clear communication from us confirming your participation in the workshop.

Please fill in this form very carefully and in sufficient detail to improve your chances of acceptance.

CAUTION!! NOTE THAT THE WORKSHOP IS NOW OVERSUBSCRIBED. BUT PLEASE DO FILL IN THE FORM IF YOU ARE KEENLY INTERESTED AND WOULD LIKE TO BE PLACED ON OUR WAITING LIST FOR THIS EVENT.

Name *

Age *

Gender you identify with *

Male

Female

Other

Nationality *

Phone *

E-mail *

Address *

Education / Occupation / Work background *

Have you attended a Jeevan Vidya Workshop earlier? If yes, when and where? *

If you ever applied for this workshop earlier but could not be accommodated, please let us know when or for which workshop you had applied.

Please provide references of people (as many as you can) through whom you have learnt about this workshop. *

Reference 1: NAME OF PERSON, & YOUR CONNECTION TO THE PERSON

Please provide references of people through whom you have learnt about this workshop.

Reference 2: NAME OF PERSON, & YOUR CONNECTION TO THE PERSON

Please provide references of people through whom you have learnt about this workshop.

Reference 3: NAME OF PERSON, & YOUR CONNECTION TO THE PERSON

How do you think this workshop would be relevant to you? *

Anything else you would like to share, or tell us?

Your accommodation preference: *

I will be happy with the dormitory accommodation and shared ashram-like facilities at the venue Suman Sangam.

I will be bringing my own tent to stay in.

I would like a separate room with attached toilet and bath at the Naturopathy centre 0.5 km from the venue. I understand that I will have to bear the expenses for such accommodation (current tariff: upwards of Rs.1200 per day), and for any vehicle hired to take me to and from the workshop venue. I also understand that availability of such accommodation is likely to be very limited.

Read carefully and tick to acknowledge: *

I understand that this workshop is an intensive immersive retreat that has to be attended in its entirety. It may not be attended partially.

I have understood this

Required

Read carefully and tick to acknowledge: *

I understand that this form is only an APPLICATION for participation in the workshop. I can consider myself duly registered as a participant only upon receiving clear communication to that effect from the organisers.

I have understood this

Required

Read carefully and tick to acknowledge: *

Please add me to your mailing list for future workshops like this.

I am so keenly interested in attending this workshop that I am willing to make arrangements to attend it at short notice. Please place me on a standby list, to be informed in case there are any 11th hour cancellations.

Required

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