Kundalini Deeksha Registration
Please fill in the below for Kundalini Deeksha registration
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First Name *
Last Name *
Address Line1 *
City *
State *
Zip
 Primary Phone *
Email *
Age *
Gender *
Profession *
Do you have any previous meditation experience? *
If Yes, where did you get meditation experience?
Purpose of taking deeksha *
Please help us to pay special attention if you have any ailments, and please describe
   Suggested Donation amount( $30)   *
(for all 3 stages)
Liability Waiver & agreement *
I understand, acknowledge and appreciate that, as with any physical activity, there is some risk of physical injury and damage associated with my participation in yoga and I assume such risk. I represent that I am in good health and suffer from no physical impairment. In consideration of the privilege of participating in the yoga program sponsored by Universal Peace Foundation of North America, I hereby release, discharge and relinquish Universal Peace Foundation of North America, and its respective officers and employees, of and from all claims, demands, actions, and causes of action of any sort, for any injuries sustained in connection with my participation in the yoga program sponsored by Universal Peace Foundation of North America. I am also placing my signature below to express sincere desires to learn Kundalini Meditation. I understand that this technique is being taught to me for the purpose of attaining inner peace, bliss, satisfaction and contentment (Santhosham). I promise that I will not disclose the meditation technique or other instructions given to me regarding meditation procedure to anyone without the written consent of the UPFNA or having completed the Instructor training (Kundalini Meditation Master Course). I have read the above release and waiver of liability and fully understand its contents.
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