You are on page 1of 1

Shiv YogAdvance Prati Prasav Sadhana Kolkata 2014

REGI STRATI ON
Service Tax No. AAJ FG9307KSD001
DD need to be made in favor of GEETANJ ALI YOG LLP, payable at New Delhi
Participation Fee comprising Basic Fee:_ _ _ _ _ _ _ _ _ , Service Tax: _________, Total Participation Fee: _________
DD No. _ _ _ _ _ _ _ _ Bank _________ Dated: ____________
----------------------------------------------------------------------------------------------------------------------------- ----------
Form No.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Receipt No.: _ _ _ _ _ _ _ _ _ _ _ _ _
Name:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Donation Amount:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Registration done by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ADVANCE PRATI PRASAV SADHANA
APPLI CANTS PERSONAL I NFORMATI ON
Name (First Middle Surname):
Date of Birth: Gender: Male Female
Please Paste your
recent Passport size
Photograph here.
Mobile No. : Email I D:
Marital Status: PAN:
Address for Communication:
City: ZI P:
State: Country:
Highest Qualification: Profession: Professional Specialization:
Shiv YogShivirs Attended
SHIVYOGSHIVIR DESCRIPTION
Place / City Name
(Where you attended
this shivir first time)
Month & Year
(When you attended this
shivir first time)
No. of times
(You attended this
type of shivir)
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
DECLARATI ON
I am participating in the SHI VYOG program at my own will. I take full responsibility for participating in this program, its outcome
whatsoever. I will maintain the sanctity of the program and keep the proceeding of the program confidential. I will maintai n the
discipline during the program and I understand that if my conduct is found to be inappropriate, I would be asked to vacate the
premises and I will be refused admission in the program. The participation fee for the program is non-refundable and non-
transferable. Use of MOBI LE PHONES is not permitted inside the venue, you are advised to not to carry it with you while attendi ng the
program. Recording of the program content by any device or mode is strictly prohibited. Anyone found recording will be
asked to leave the venue and his registration will be cancelled.
I confirm that all the information is true to the best of my knowledge.
Signature of Applicant Place Date
Kolkata-2014
(6
th
- 10
th
Aug)
Shiv YogAdvance Prati Prasav Sadhana Kolkata 2014
REGI STRATI ON
Service Tax No. AAJ FG9307KSD001
DD need to be made in favor of GEETANJ ALI YOG LLP, payable at New Delhi
Participation Fee comprising Basic Fee:_ _ _ _ _ _ _ _ _ , Service Tax: _________, Total Participation Fee: _________
DD No. _ _ _ _ _ _ _ _ Bank _________ Dated: ____________
----------------------------------------------------------------------------------------------------------------------------- ----------
Form No.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Receipt No.: _ _ _ _ _ _ _ _ _ _ _ _ _
Name:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Donation Amount:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Registration done by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ADVANCE PRATI PRASAV SADHANA
APPLI CANTS PERSONAL I NFORMATI ON
Name (First Middle Surname):
Date of Birth: Gender: Male Female
Please Paste your
recent Passport size
Photograph here.
Mobile No. : Email I D:
Marital Status: PAN:
Address for Communication:
City: ZI P:
State: Country:
Highest Qualification: Profession: Professional Specialization:
Shiv YogShivirs Attended
SHIVYOGSHIVIR DESCRIPTION
Place / City Name
(Where you attended
this shivir first time)
Month & Year
(When you attended this
shivir first time)
No. of times
(You attended this
type of shivir)
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
DECLARATI ON
I am participating in the SHI VYOG program at my own will. I take full responsibility for participating in this program, its outcome
whatsoever. I will maintain the sanctity of the program and keep the proceeding of the program confidential. I will maintai n the
discipline during the program and I understand that if my conduct is found to be inappropriate, I would be asked to vacate the
premises and I will be refused admission in the program. The participation fee for the program is non-refundable and non-
transferable. Use of MOBI LE PHONES is not permitted inside the venue, you are advised to not to carry it with you while attendi ng the
program. Recording of the program content by any device or mode is strictly prohibited. Anyone found recording will be
asked to leave the venue and his registration will be cancelled.
I confirm that all the information is true to the best of my knowledge.
Signature of Applicant Place Date
Kolkata-2014
(6
th
- 10
th
Aug)
Shiv YogAdvance Prati Prasav Sadhana Kolkata 2014
REGI STRATI ON
Service Tax No. AAJ FG9307KSD001
DD need to be made in favor of GEETANJ ALI YOG LLP, payable at New Delhi
Participation Fee comprising Basic Fee:_ _ _ _ _ _ _ _ _ , Service Tax: _________, Total Participation Fee: _________
DD No. _ _ _ _ _ _ _ _ Bank _________ Dated: ____________
----------------------------------------------------------------------------------------------------------------------------- ----------
Form No.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Receipt No.: _ _ _ _ _ _ _ _ _ _ _ _ _
Name:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Donation Amount:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Registration done by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ADVANCE PRATI PRASAV SADHANA
APPLI CANTS PERSONAL I NFORMATI ON
Name (First Middle Surname):
Date of Birth: Gender: Male Female
Please Paste your
recent Passport size
Photograph here.
Mobile No. : Email I D:
Marital Status: PAN:
Address for Communication:
City: ZI P:
State: Country:
Highest Qualification: Profession: Professional Specialization:
Shiv YogShivirs Attended
SHIVYOGSHIVIR DESCRIPTION
Place / City Name
(Where you attended
this shivir first time)
Month & Year
(When you attended this
shivir first time)
No. of times
(You attended this
type of shivir)
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
DECLARATI ON
I am participating in the SHI VYOG program at my own will. I take full responsibility for participating in this program, its outcome
whatsoever. I will maintain the sanctity of the program and keep the proceeding of the program confidential. I will maintai n the
discipline during the program and I understand that if my conduct is found to be inappropriate, I would be asked to vacate the
premises and I will be refused admission in the program. The participation fee for the program is non-refundable and non-
transferable. Use of MOBI LE PHONES is not permitted inside the venue, you are advised to not to carry it with you while attendi ng the
program. Recording of the program content by any device or mode is strictly prohibited. Anyone found recording will be
asked to leave the venue and his registration will be cancelled.
I confirm that all the information is true to the best of my knowledge.
Signature of Applicant Place Date
Kolkata-2014
(6
th
- 10
th
Aug)

Related Interests