Holistic living workshop

Workshop Mode

OnlineOffline

Venue:

From:
To:

Time:
To:

No of Days:

Name:
Age: yrs

Gender:—Please choose an option—MaleFemale

Occupation:—Please choose an option—StudentServiceH-WifeResearch Scholar

Mob No.:
Email Id:

Willing to join google group:

YESNO

Purpose of practicing holisticyog (Holistic Health Information)

Physical:

Weight ControlFitnessDigestion DisorderRespiratory TroubleJoint PainBack PainThyroidB.P.SugarTired FeelingAllergies

Other if any:

Psychological/Emotional:

InsomniaMood SwingLacking MotivationRespiratory TroublePoor ConcentrationFearAngerAnxietyRestlessnessStressLonelinessBoredomDepressionLow Self Esteem

Other:

Spiritual:

Want of inner peaceUnable to enjoy life and workDifficult relationshipFailed affairs

Any other specific issues and concerns:

Doctor's diagnosis for chronic disease (if any):

Any recent surgery (if any):

Are you currently under any type of medication?:

I declare that all relevant information given by me on this form is correct to my belief and I take the responsibility for myself in attending the holistic-yog workshop and any consequences thereof.

Date:

Signature of Participant:

Note: If one has any doubt whether 'holisticyog' can be practiced with a particular health condition, consult beforehand and inform any ill feeling to the instructor during practice.

Registration (Rs):
Remuneration (Rs):

+For Online Payment - Acct. No: 10224422221 | Name: Tapas Kumar Maili | IFSC: SBIN0000202