APPLICATION FOR SIDDHA MEDITATION INTENSIVE

NAME:                                                            (Male/Female)                                       

AGE:                            OCCUPATION:

COMPLETE ADDRESS:

TELEPHONE:

Email :

I have/have not  participated in any Siddha Meditation Intensive before.

Declaration: "I have read and understood all the rules of the Siddha Meditation Intensive and shall follow them correctly".

The Registration fees of Rs. 1200/-(For Indians) US$50 ( For Foreigners)  is enclosed by means of : Demand Draft / Money Order (Non transferable & non refundable) .

Details:

CHOICE OF DATE OF INTENSIVE: 

15^th August 2008, 16^th November 2008

I request you to kindly permit me to participate in the Siddha Meditation Intensive.

Date:                                                                                   

Signature

_______________________________________________________________________

For Siddha Yoga Dham Office use only:

Receipt No.:

Date:

Registration No.:

Permitted to participate

_____________________

Spiritual Head

Siddha Yoga Dham, Bangalore