Application Form for Yoga & Sound at Arsha
Vidya Grurkulam, Pennsylvania.
September 11 to 18, 2008
Please submit one form per
person with original signature
– even if paying by a single payment for shared occupancy. Retain
a copy of completed Application Form for your records.
Please register me for
this workshop. I have read the flyer for this workshop and agree with all the
stipulations therein, including ÒRefund PolicyÓ and ÒType of Occupancy.Ó
Name:
_____________________________________________________________________
Male/Female ________________
Mailing Address:
________________________________________________________________________________________
City/State/Zip/Country:___________________________________________________________________________________
Phone:
___________________________ Cell:
_______________________ Email: __________________________________
State here TYPE of
occupancy you are requesting (see Type 1 thru 7 on the flyer - Type 2 is no longer available)
ÉÉÉÉÉÉÉÉÉÉÉ.. _______
If that
preferred Type is not available will you accept the next available Type of
accommodation?
Circle Yes or No. If
you choose NO, you may be asked to stay at a motel for an additional fee. YES
NO
To apply before July 11, 2008
please include at least $100 deposit per person; after July 11, please pay the
full fee. State
here amount of deposit enclosed ...ÉÉÉ.ÉÉÉÉ. $_______
Rooms are allocated on a
first come basis after the full payment is received.
State here the
balance you will remit by July 11, 2008 ÉÉÉ $_______
Additional nights (limited
accommodation available at $80 per night). No. of nights _____. Amount ÉÉ...... $ _______
Total (Make Checks payable
to Ramanand Patel) ÉÉÉ..........ÉÉÉ........É..ÉÉÉÉÉÉÉÉÉÉÉÉÉ $_______
To pay by PayPall
or Credit Card, go the next page to make a payment. Then complete the following line:
I have paid the above amount by using BUY NOW Button on (date): ____________.
If applying for double/triple occupancy please
print clearly
name of
partner. Otherwise partners will
be assigned by Ramanand.
Provide the following
information to be used in the event of an emergency:
Name of (and relationship
to) contact person:
ÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉ...........ÉÉÉÉÉÉÉÉÉÉÉ
Phone of contact person:
ÉÉÉÉÉÉÉÉÉÉÉÉÉ..ÉÉ........É E-mail: ÉÉÉÉ.ÉÉÉÉÉÉÉÉÉÉÉÉÉÉ
Scholarship: Visit
www.yogirama.com/scholarship.html to apply for a scholarship OR to add to
this fund.
For more information visit www.yogirama.com OR contact Nila
Patel at the following address.
Include special diet needs if any in a separate letter with this
application.
State here the names of the persons ........................................................................................
for whom you claim the 5% rebate .........................................................................................
__________________________________________________ ______________
Signature Date
Mail signed application form with fee (payable to
Ramanand Patel) to: Nila Patel, 4926 Maranatha Way, Allentown, PA-18106. Phone:
1.610.706.3196 OR e-mail: Nilasur@aol.com. Additional information will
be sent to you after registration. Form
revised 8/21/07.
Page 2
It helps to keep the costs down if you pay by check. However, if you need to pay by PayPall or Credit Card, first select the Type of accomodation
you are requesting and then use the BUY NOW Button below. Print and mail the page 1 of the Application Form with your original signature to Nila Patel.
ÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉÉ...........ÉÉÉÉÉÉÉÉÉÉÉ