Registration Form

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Registration Form

Namaskaram, we are happy to Welcome you to join our Upcoming Programs.

All the programs at Yoga Mithraa are a transformative process not only on the level of your Body but in the way you are.

All the prices mentioned in the Form are inclusive of 18% GST.

Kindly fill out the form to Register.

Which program would you like to Register? Kindly note that these programs are happening in Yoga Mithraa Studio in Salem, Tamil Nadu.

Angamardana

Yogasanas

Monthly Sadhana

Other:

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First Name *

Last Name *

Age: *

Gender: Female/Male *

Female

Male

Other:

Education Qualification

Occupation *

Residential Address *

City *

State, Country *

Zip/Postal Code *

Mobile Number *

Email *

Emergency Contact Name, Relationship and Phone Number *

How did you come to know of this program *

Please give details of yoga or meditation you have practiced and how long you have been practicing *

Have you learnt any other Isha Yoga practices? Yes / No. If yes, please give details below

Any Serious illness in the last three years

Yes

Any Injury in the last three years

Yes

Surgery in the last three years

Yes

Psychotherapy, psychological therapy and counseling in the last five years

Yes

If any of the above is selected as Yes, please give details of the nature and duration of the condition and ifyou are currently undergoing any treatment:

H/O Smoking

Yes

H/O Drugs

Yes

H/O Alcohol

Yes

For women, Are you currently pregnant or planning for pregnancy ?

Yes

Any other comments:

Payment Mode

Net banking

G Pay

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Payment details:

1. Netbanking details:

Account Name- Yoga Mithraa

Account No.- 50200069279983

IFSC Code- HDFC0001281

2. Gpay number- 9994077083- Saranya V

Kindly send us the screenshot of the Payment done.

Address & Map Location:

https://g.page/yogamithraa

Yoga Mithraa

Classical Hatha Yoga Studio

153, Avvai Nagar,

Jagir Ammapalayam,

Salem-636302

Landmark:

Opposite to Vennankodi Muniyappan Kovil,

On the way to Senthil Public School

Contact: +91 9677743020 /

+91 9677743021

* I hereby declare that the above information is true, accurate and complete to the best of my knowledge.

* I also assure that I am not withholding any information.

* I also agree to attend this program in full.

* I shall take responsibility for the results, and indemnify the organisers against all claims and suits.

* I will not communicate the contents of the program, either directly or indirectly to any third party, and will not record any of the sessions, or share any such recordings with others.

* All the Workshops and their fees are non-refundable and non-transferable.

* I understand that the Instructor at Yoga Mithraa cannot provide Medical Advice.

* I also understand that the classes taught and the practices offered here are not meant to replace any form of Medication or Medical Treatment that I am currently seeking now or in the future.

* My acknowledgment below confirms that the above information is accurate and complete to the best of my knowledge and I understand that the practices is for my personal benefits but does not enable me to teach yoga to any other person.

I accept the above Terms and Conditions.

Required

Welcome to the Journey of Science of Being

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