VED VIGNAN MAHA VIDYA PEETH “Panchagiri Educational Campus “, Udayapura, 21st Km, Kanakapura Road, Bangalore South ~ 560082 THE ARTOFLIVING pp, .91-80-28432273 Fax: +91-60-28432832 Email: ashram@vvmwp.org Reason for Stay: Block: No: Name: Age: Gender [JM [JF Address: Districts State: Country: Pincodet Contact No. (Residence): Mobile No: Email: ‘Occupation: Date of Arrival & Time: Date of Departure & Time: Teacher: Course Date: Place: (J Pin ‘Triple ]5Sharing [_] Dorm Present Health Condition: Previous Psychiatric History if any: Seva Preferred: Kitchen / Housing / Campus Maintenance / Emergency Clinic (Doctors only) Registration Amount / Contribution: Referred by: ‘Teachers Code: Full Time Pare Time Courses you teach: DECLARATIONS tam parang in ths ART OF LIVING prone on my own and Take fll espns for pacing in his progam. [ree VWKT/ VWMVE al organisa asitns rom ll damages whaoeve and wave al igh wo compensiion in cs of jn. dela chat Ham tpl and eter able to priate indi progumne | wil notch any echnigies ofthe nus nles SRI SRI RAVI SHANKAR fly peaonally {runed me, Alar amination eserves al gts forthe change of conodaon wi ot wikou any pir information. wil ot engage In any att not tefiamg which sdrogatory othe ares cond expected nthe abr, hs ailing the asa ules as wel Place: Date Signature