Registration Form

What Hatha Yoga Does is - if you consciously hold the body in an asana, it can alter the way you think and feel and experience life.

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Choose Your Month*

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Name you prefer to be called

Gender*

Male

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Age*

Education Qualification

Occupation

Mobile*

Address (Street, City, Postal code, State/ Country)*

Emergency Contact Name, Relationship and Phone Number:

How did you come to know of this program:

Please give details of yoga or meditation you have practiced and how long you have been practicing

Have you learnt any other Isha Yoga practices? Yes / No. If yes, please give details below:

Please indicate below if you currently or previously have had any physical or mental ailments. For Ex. Hernia, Neck or Back disease, Dislocations, Joint replacements, Injury, Depression, Anxiety etc. Please give details of the nature and duration of the condition and if you are currently undergoing any treatment:

For women, Are you currently pregnant?*

yes

Have you had any major surgery in the last six months? Yes / No

Program Cost & Accommodation Type*

Shuddhi Fees - 1500

I hereby willingly undertake to attend this program completely. I take full responsibility for the result and indemnify the organizers against all claims and suits. I will not communicate the contents of the program, either directly or indirectly to anyone else. I understand the participation guidelines and agree to follow them. I hereby declare that the above information is true, accurate and complete to the best of my knowledge. Please sign with Date & Place, Name *

Refund Policy

Contacts

leela.hathayoga@gmail.com

+91 7206602665

Address

Leela hatha yoga, balaknath road,

Upper tapovan, Rishikesh, Uttrakhand

Leela - Hatha Yoga & Stay

leela.hathayoga@gmail.com

Mobile & Whatsapp:

+917206602665

+91 9819746781

Balaknath Rd, Upper Tapovan, Rishikesh,

Near Secret Garden/ Blue Guest House,

Uttarakhand 249137, India

Email address