THE ART OF LIVING COURSE PART - 1

APPLICATION FORM
VYAKTI VIKAS KENDRA, INDIA
GUJARAT APEX BODY
Website : http://www.artofliving.org
(Please write clearly and in BLOCK LETTERS. All information in this application will be kept strictly CONFIDENTIAL)

Name ___________________________________________________ Male Female

Home Address __________________________________________________________________
______________________________________________________________________________
Office Address __________________________________________________________________
_______________________________________________________________________________
Phone : (Resi) : _________________ Office : __________________ Fax : ________________
Mobile : ________________________ E- mail : ________________________________________
Date Of Birth ____________ Profession: ________________________ Married Unmarried

1. Are you experiencing any of the following health problems?

Asthma Epilepsy High Blood Pressure Schizophrenia
Heart Problem Back Pain Pregnancy
Other (Specify)

2. Are you taking currently any prescribed medication?

Yes No If yes, Please Explain :

3. Have ever undergone psychiatric treatment before?

Yes No If yes, Please Explain :

4. Please list any other programs in the field of self development you have participated in or taught
yourself _______________________________________________________________________
5. How did you come to know about THE ART OF LIVING?
______________________________________________________________________________
___________________________________________________________________________
Declaration
I am participating in this ART OF LIVING program of my own and I take full responsibility for
participating in this program. I release Vyakti Vikas Kendra India all organizers and assistants in this
program from all damages whatsoever and waive all rights to compensation in case of injury. I
declare that, I am physically and mentally able to participate in this program. I will not teach any
techniques of this course unless I have been fully personally trained by SRI SRI RAVISHANKAR.
Place : Signature
Date :
PERSONAL DONATION FOR THE COURSE Rs._________ Cash/Cheque No. ____________ Date _________
Company sponsored Bank Name _____________________________

Name of the instructor __________________________Course Date from _____________to __________

 JAI GURUDEV

For Office Use Only

Acknowledgement for THE ART OF LIVING BASIC COURSE- HAPPINESS PROGRAM
Received BY ______________________________a sum of Rs. ___________________________
By Cash / Checque / DD No. _______________Dated _____________ Drawn On ________________

VVKI GUJARAT Apex Body

Website : http://www.artofliving.org
Signature of Receiver CONTACT OF RAJKOT AOL TEACHER
Date ___________ DR HEMANG S JANI:
9033762190 / 8485948315

VYAKTI VIKAS KENDRA, INDIA

GUJARAT APEX BODY
Website : http://artofliving.org

RULES AND REGULATION

1. Please fill the application form clearly and in CAPITAL LETTERS.

2. Course participants must attend all sessions of the course without any exception.
3. Smoking, drinking, alcohol is not permitted through the duration of the course.
4. Please wear loose fitting, comfortable clothes during the course.
5. Be well rested when you attend the course.
6. Do not eat a meal at lest 2 hours before the course.