Registration

Online Offline
Venue: From: To:
Time: To: No of Days:

Conducted By: Dr. T. K. Maiti & Mrs Mitali Maiti, of Holistic Yog Management Nest(hymn)
Yogananda Arogya Bhaban. Hijli Co-Operative, Kharagpur-721306
Govt. Regn No: IV/235/2010. Estd:20-10-2010 Mob:9434056321/9564138104
WhatsApp: 8637869921 E-Mail: tkm.hymn@gmail.com
Website:https://holisticyog.com/

Registration Form
(Confidential)

Name:    Age: yrs

Mob No::    Email Id::    Willing to join google group:

Purpose of practicing holisticyog (Holistic Health Information).


Physical:
   other if any:

Psychological/Emotional:
  
other :

Spiritual:
    Any other specific issues and concerns:

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

Any recent surgery (if any):

Are you currently any type of medication?:

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

date:

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

Registration: Rs  Remuneration: Rs 

+For On Line Payment - Acct. No: 10224422221 Name Tapas Kumar Maili IFSC-SBIN0000202


    Registration Form
    (Confidential)

    Preferred Schedule:

    Name:
    Age: yrs

    Mob No.:
    Email Id:

    Purpose of practicing holisticyog (Holistic Health Information)

    Physical: Body Weight:

    Other if any:

    Psychological/Emotional:

    Spiritual:


    Any other specific issues and concerns?

    Doctor's diagnosis for chronic disease?

    Any recent surgery?

    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:

    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

    Gpay Number : +91 9434056321