Yoga & Sound Workshop, February 13 to 27, 2011, in Rishikesh, India
Application Form including Terms and Conditions (Revision 2 - March 3 2010)
(Payment by Credit Card or PayPal)
I accept of all the TERMS AND CONDITIONS for this workshop in Rishikesh, India, in 2011.
Signature: __________________________________ Date:__________________
Name: (Print as it is in Passport ________________________________________
stating Male/Female/Child)
Address: ________________________________________ Apt. ______________
City: _________________________ State: _____________ Zip: _____________
Home Phone: _____________________ Work Phone: _____________________
Fax: _______________________ Email: ________________________________
Recommending person for discount if any _______________________________
Type of occupancy: (double, single, spouse, friend,child). ______________________
For double occupancy name the person you would like to share the room
with. If no such name is indicated, one will be assigned to you. ______________________
If registering for less than two weeks, state the dates: _____________________
Send me information on the sight-seeing trip after the workshop. Circle one: YES / NO
In an emergency,
please contact: Name: __________________________ Relationship: __________
Phone:_____________________ E-mail:_______________________________
Choose the appropriate item from the draw down menu below before using the BUY
NOW Button. Remember to add 3% non-refundable processing fee. Then complete the following line and mail
this page with original signature to Nila Patel, 4926 Maranatha Way, Allentown, PA-18106.
I have paid the above amount by using BUY NOW Button on (date): ____________.
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