~ REGISTRATION FORM ~ Shakti Sadhana: A Woman's Pilgrimage into the Indian Himalayas
FULL NAME (AS IT APPEARS ON YOUR PASSPORT) *
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E-MAIL ADDRESS *
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CONFIRM E-MAIL ADDRESS *
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FULL MAILING ADDRESS *
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PHONE NUMBER *
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DATE OF BIRTH *
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PASSPORT NUMBER *
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VISA NUMBER (IF AVAILABLE) *
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FOOD OR MEDICATION ALLERGIES *
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DIETARY AND/OR OTHER SPECIAL REQUIREMENTS. PLEASE GIVE DETAILS. *
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HEALTH OR MEDICAL CONDITIONS. PLEASE GIVE DETAILS. *
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EMERGENCY CONTACT (NAME/PHONE/E-MAIL/RELATIONSHIP) *
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WHY WOULD YOU LIKE TO JOIN SHAKTI SADHANA? *
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PLEASE TELL US ABOUT YOUR YOGA AND MEDITATION EXPERIENCE. *
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HAVE YOU TRAVELLED TO INDIA? IF SO, PLEASE TELL US ABOUT YOUR EXPERIENCE. HAVE YOU TRAVELLED TO OTHER INTERNATIONAL DESTINATIONS? IF SO, PLEASE TELL US ABOUT YOUR EXPERIENCE. *
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HOW DID YOU HEAR ABOUT SHAKTI SADHANA? PLEASE BE SPECIFIC. *
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I understand that I will have to pay a $500 USD deposit to confirm my registration. (Due immediately.) *Please contact us for details on making payment: satya@prakaasha.ca or yogawithyes.info@gmail.com. *
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