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Program Registration
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Program Name
12 Day Hatha Yoga (Up Yoga, Surya Kriya, Nadi Shuddhi, Isha Kriya, Yogasana) 8000/-
21 Days Hatha Yoga (Up Yoga, Surya Kriya, Nadi Shuddhi, Isha Kriya, Yogasana, Angamardana) 12000/- )
Angamardana - Builds physical strength, fitness and tenacity along with weight loss (INR 4500/-)
Bhuta Shuddhi - Creates the basis to gain complete mastery over the human system (INR 3500/- including Kit worth 2050/-)
Surya Shakti - Makes the sinews and ligaments of the body strong & Mental alertness & Focus (INR 2500/-)
Surya Kriya - Develops mental clarity and focus (INR 3000/-)
Up Yoga - Strengthens the joints and muscles, relieves tiredness & stress (INR 1500/-)
Yogasana - Relief of chronic health conditions, decelerates aging. (INR 4000/-)
Yoga Namaskar - A very simple and complete process by itself offering all round benefits for the entire body (INR 400/-)
Nadi Shuddhi - Relieve anxiety, stress and psychological tension (INR 500/-)
Isha Kriya -Develop mental clarity and focus, peace and wellbeing (INR 200/-)
Other:
Name (First, Middle, Last)
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Name you prefer to be called
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Mobile No.
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Gender
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Male
Female
Age
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Education Qualification
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Occupation
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Residential Address (City, State, Pin)
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Emergency Contact Name, Relationship and Phone Number
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How did you come to know of this program:
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Have you learnt any other Isha Yoga practices? Yes / No. If yes, please give details below:
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Please give details of any other yoga or meditation you have practiced/are practicing; and for what duration:
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Please indicate below if you currently or previously have had any of these physical or mental ailments.
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In case of any Covid related symptom, kindly mention in 'Other' option.
None
Any physical limitations or disabilities
Bowel/Bladder issues
Bleeding disorders
Chronic pain
Covid/ Omicron in past 60 days (If yes, upload negative RT-PCR/ test report)
Communicable disease
Depression/ Psychosis
Diabetes
Glaucoma / retinal detachment /eye surgery
Hernia
Heart conditions
High blood pressure
Joint-related issues
Ligament injuries
Low blood pressure
Neck/Back aches/ injuries
Respiratory conditions
Seizures/Epilepsy
Spinal conditions
Stroke
Hospitalization for a psychiatric condition in the past
Other:
If any of the above is selected as Yes, kindly provide details of nature and duration of the condition and if you are currently undergoing any treatment:
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Have you had any major surgery in the last six months?
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Are you currently pregnant or planning for pregnancy?
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Yes
No
Not applicable
Smoking
Yes
No
Clear selection
Drugs
Yes
No
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Alcohol
Yes
No
Clear selection
Any other comments:
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Declaration
"By submitting this form, I hereby willingly agree to attend this program completely. I take full responsibility for the result and indemnify the organizers against all claims and suits. I will not communicate the contents of the program, either directly or indirectly to anyone else. I understand the participation guidelines and agree to follow them. I hereby declare that the above information is true, accurate and complete to the best of my knowledge"
Date and Place
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