Application Form - Yoga & Sound - Arsha Vidya Grurkulam, PA, USA. September 6 to 13, 2017 – Wednesday to Wednesday
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.
Name: __________________________________ Male/Female _______
Mailing Address: ___________________________________________
Phone:___________ Cell:___________ Email:___________________
Rooms are allocated after full payment is received. If the TYPE you choose is not available you will accept the next available Type. If not, you may be asked to stay at a motel for an additional fee. You will be considered Type 1 occupant and will be responsible for transportation to and from the motel.
Please check the Type 1 to 7 at www.yogirama.com/AVG17Flyer.htm and indicate the Type you wish to request: TYPE __________ _____________________________________________________________
The amount of deposit included with this application ÉÉÉÉ $ __________
(Before July 6, 2017 please pay at least $100 deposit per person. After July 6, pay the full fee).
Additional nights (limited accommodation available at $80 per night).
No. of nights _________ Amount ÉÉÉÉ..É...... $ __________
Total (Make Checks payable to Ramanand Patel) É...ÉÉÉÉ $ __________
To pay by Paypal or credit card send an email to email@example.com stating the amount you wish to pay NOW and Type of room requested. You will receive an invoice; it will enable you to make the payment. A 5% processing fee will be added to the fees. This 5% fee will not be refunded in the event you cancel.
TYPE ___________________ Amount you wish to pay now $ __ ________
The balance you will remit by July 6th 2017ÉÉÉÉÉÉÉÉÉÉ..ÉÉ.ÉÉÉ.. $ ___ _______
You will receive an invoice by e-mail for the balance due on or about June 6th unless you have paid the balance. Page 1 of 2
Provide the following information to be used in the event of an emergency.
Name of Contact Person: ....................................
Relationship of Contact Person: ............................
E-mail:....................... Phone: ......................
If applying for double/triple occupancy please print clearly name(s) of partner(s). Otherwise partners will be assigned by Ramanand. For Type 4 occupancy you must already have a partner.
Please register me for this workshop. I have read the flyer for the workshop and agree with all the stipulations therein, including ÒRefund PolicyÓ and ÒType of Occupancy.Ó
___________________________________ ______________ Signature Date
Print and mail both pages of the Application Form with your original signature and with fee (payable to Ramanand Patel) to:
Nila Patel, 4926 Maranatha Way, Allentown, PA-18106. Phone: 1.610.706.3196 E-mail: Nilasur@aol.com.
Additional information will be sent to you after registration.
For more information visit www.yogirama.com OR contact Nila Patel.
Include special diet needs if any in a separate letter with this application.
Form revised January 6, 2017.
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