Kumbh Registration Form
Name of Retreat *
PERSONAL INFORMATION
Please let us know a few details about yourself
Full Name: xxxxxxx *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
E-mail Address: *
Your answer
Postal Address: *
Your answer
Telephone/Mobile#: (with country code) *
Your answer
Gender: *
Nationality: *
Your answer
Country of Residence: *
Your answer
EMERGENCY CONTACT INFORMATION
Full Name: *
Your answer
Gender: *
E-mail Address: *
Your answer
Postal Address: *
Your answer
Telephone/Mobile#: *
Your answer
Country of Residence: *
Your answer
Relationship: *
Your answer
HEALTH CONDITIONS:
Do you have any major health problems including surgeries, genetic disorders or any kind of psychosomatic illness? *
Your answer
Are you taking any medications? If yes, please specify: *
Your answer
Do you have dietary restrictions? If yes, please specify: *
Your answer
What is your Blood Group? *
Your answer
How do you rate your consistency in spiritual practices? *
Please let us know your T-shirt size as we will be providing T-shirts to all confirmed participants. *
GENERAL INFORMATION
How did you first hear about this retreat? *
Have you ever participated in any other Gurulight retreat/trips? *
Your answer
What do you expect from this trip? What do you hope to gain from it? *
Your answer
NOTES AND RECOMMENDATIONS
Your safety will always be our highest concern. Based on your health/medical details provided in your application form, Gurulight Team may request you to furnish a provisional clearance from your doctor and/or, optionally, a go-ahead from your next-of-kin as a pre-condition for registration.
TERMS AND CONDITIONS
I hereby confirm that I have personally filled all the information correctly and consciously, and I am fully responsible for attending this retreat. *
Required
I take full responsibility for my physical condition including consulting with a medical practitioner to evaluate my health condition. I confirm that Gurulight, any of the people or venues associated with Gurulight will bear no liability should any medical matter arise and I shall be financially responsible for any consequential medical, evacuation, accommodation or related expenses *
Required
I hereby agree that Gurulight or any of the people or venues associated with Gurulight shall not be responsible for any of the possible consequences related to the attendance to the retreat. I hereby agree Gurulight, including all organizers and assistants associated with Gurulight will not be held responsible for any loss or damage whatsoever and I waive all rights to compensation in case of injury or loss. *
Required
I understand that the registration is complete only after paying the full fee and that the contribution is non-refundable and registration is non-transferable. Likewise, any changes in the schedule of the program by Gurulight will be notified in advance. In case of cancellation of the program, attributed to any cause that is beyond the reasonable control, including natural disasters like floods, fire, tempest or conditions caused by men, such as war, revolutions etc. the program charges will not be refundable. *
Required
I welcome supporting Gurulight and its associates by enabling them to use my images, if necessary, and video footage in its publications and media placements. Should I wish to be excluded, it is my responsibility to inform Gurulight organizers at the time of registration.
THANK YOU FOR YOUR TIME
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