Program Registration Form
Program Name
Your answer
Start Date
MM
/
DD
/
YYYY
End Date
MM
/
DD
/
YYYY
First Name
Your answer
Last Name
Your answer
Name you to prefer to be called
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Age
Your answer
Gender
Education Qualification
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Occupation
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Residential Address
Your answer
City
Your answer
State, Country
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Zip/Postal Code
Your answer
Mobile Number
Your answer
Email
Your answer
Emergency contact name, Relationship, and Phone number
Your answer
How did you come to know of this program
Your answer
Please give details of yoga or meditation you have practiced and how long you have been practicing
Your answer
Have you learned any other Isha Yoga practices?
if Yes, please give details below:
Your answer
Please indicate below if you currently or previously have had any physical or mental ailments. For Ex. Hernia, Neck or Back disease, Dislocations, Joint replacements, Injury, Depression, Anxiety, etc. Please give details of the nature and duration of the condition and if you are currently undergoing any treatment.
Your answer
For women, Are you currently pregnant?
Have you had any major surgery in the last six months?
I hereby willingly undertake 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.
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