Application form for Jeevan Vidya Workshop at Dharwad, Karnataka (27 Apr - 4 May 2019)

Please note that the workshop is in the nature of an intensive immersive retreat that has to be attended in its entirety. It may not be attended partially. Participants are expected to arrive by the evening of 26th April, and may leave after lunch on the 4th of May, 2019.
This form is an application for individual participation only.
You should consider yourself duly registered only after you receive clear communication from us confirming your participation in the workshop.

Please fill in this form very carefully and in sufficient detail to improve your chances of acceptance.

CAUTION!! NOTE THAT THE WORKSHOP IS NOW OVERSUBSCRIBED. BUT PLEASE DO FILL IN THE FORM IF YOU ARE KEENLY INTERESTED AND WOULD LIKE TO BE PLACED ON OUR WAITING LIST FOR THIS EVENT.
Name *
Your answer
Age *
Your answer
Gender you identify with *
Nationality *
Your answer
Phone *
Your answer
E-mail *
Your answer
Address *
Your answer
Education / Occupation / Work background *
Your answer
Have you attended a Jeevan Vidya Workshop earlier? If yes, when and where? *
Your answer
If you ever applied for this workshop earlier but could not be accommodated, please let us know when or for which workshop you had applied.
Your answer
Please provide references of people (as many as you can) through whom you have learnt about this workshop. *
Reference 1: NAME OF PERSON, & YOUR CONNECTION TO THE PERSON
Your answer
Please provide references of people through whom you have learnt about this workshop.
Reference 2: NAME OF PERSON, & YOUR CONNECTION TO THE PERSON
Your answer
Please provide references of people through whom you have learnt about this workshop.
Reference 3: NAME OF PERSON, & YOUR CONNECTION TO THE PERSON
Your answer
How do you think this workshop would be relevant to you? *
Your answer
Anything else you would like to share, or tell us?
Your answer
Your accommodation preference: *
Read carefully and tick to acknowledge: *
I understand that this workshop is an intensive immersive retreat that has to be attended in its entirety. It may not be attended partially.
Required
Read carefully and tick to acknowledge: *
I understand that this form is only an APPLICATION for participation in the workshop. I can consider myself duly registered as a participant only upon receiving clear communication to that effect from the organisers.
Required
Read carefully and tick to acknowledge: *
Required
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