“THE ART OF LIVING” COURSE PART - 1
APPLICATION FORM
VYAKTI VIKAS KENDRA, INDIA
GUJARAT APEX BODY
Website : http://www.artofliving.org
(Please write clearly and in BLOCK LETTERS. All information in this application will be kept strictly CONFIDENTIAL)
Name ___________________________________________________
Male
Female
Home Address __________________________________________________________________
______________________________________________________________________________
Office Address __________________________________________________________________
_______________________________________________________________________________
Phone : (Resi) : _________________ Office : __________________ Fax : ________________
Mobile : ________________________ E- mail : ________________________________________
Date Of Birth ____________ Profession: ________________________
Married Unmarried
1. Are you experiencing any of the following health problems?
Asthma
Epilepsy
High Blood Pressure
Heart Problem
Back Pain
Pregnancy
Other (Specify)
Schizophrenia
2. Are you taking currently any prescribed medication?
Yes
No
If yes, Please Explain :
3. Have ever undergone psychiatric treatment before?
Yes
No
If yes, Please Explain :
4. Please list any other programs in the field of self development you have participated in or taught
yourself _______________________________________________________________________
5. How did you come to know about THE ART OF LIVING?
______________________________________________________________________________
___________________________________________________________________________
Declaration
I am participating in this “ART OF LIVING” program of my own and I take full responsibility for
participating in this program. I release Vyakti Vikas Kendra India all organizers and assistants in this
program from all damages whatsoever and waive all rights to compensation in case of injury. I
declare that, I am physically and mentally able to participate in this program. I will not teach any
techniques of this course unless I have been fully personally trained by SRI SRI RAVISHANKAR.
Place :
Signature
Date :
PERSONAL DONATION FOR THE COURSE Rs._________ Cash/Cheque No. ____________ Date _________
Company sponsored
Bank Name _____________________________
Name of the instructor __________________________Course Date from _____________to __________
JAI GURUDEV
For Office Use Only
Acknowledgement for “THE ART OF LIVING BASIC COURSE-“ HAPPINESS PROGRAM”
Received BY ______________________________a sum of Rs. ___________________________
By Cash / Checque / DD No. _______________Dated _____________ Drawn On ________________
Signature of Receiver
Date ___________
VVKI – GUJARAT Apex Body
Website : http://www.artofliving.org
CONTACT OF RAJKOT AOL TEACHER
DR HEMANG S JANI:
9033762190 / 8485948315
VYAKTI VIKAS KENDRA, INDIA
GUJARAT APEX BODY
Website : http://artofliving.org
RULES AND REGULATION
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Please fill the application form clearly and in CAPITAL LETTERS.
Course participants must attend all sessions of the course without any exception.
Smoking, drinking, alcohol is not permitted through the duration of the course.
Please wear loose fitting, comfortable clothes during the course.
Be well rested when you attend the course.
Do not eat a meal at lest 2 hours before the course.