Happiness Form For All Level I Courses

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The Art of Living – Nepal

Happiness Program/Sri Sri Yoga I/Living Well Course Form


Name (IN CAPITALS) __________________________________________________________ Male/ Female Married/unmarried

Date of Birth (DD/MM/YY) ____________________________________________________ Occupation ________________________

Home Address: ___________________________________________________________________________________________________

Office Address: ________________________________________________________________ Designation ________________________

Email ID ______________________________________________________________________ Mobile No._________________________

Phone No Res. _______________________________ Off. ______________________________ Fax _______________________________

1. Are you suffering from/undergoing any of the following? Please tick.

Asthma Epilepsy High Blood pressure

Heart Problem Back pain Pregnancy

Other (Specify) ___________________________________________________________________________________________

2. Are you currently taking any prescribed medication?

Yes/ No If yes, please explain ______________________________________________________________________________

3. Have you ever undergone any psychiatric treatment before?

Yes/No If yes, please explain ______________________________________________________________________________

4. Please mention any self development program you have undergone or teaching.

________________________________________________________________________________________________________

5. How did you know about Art of Living?

________________________________________________________________________________________________________

Declaration

I understand that any benefit derived from this course depends upon the extent of my participation. I therefore, accept full responsibility for
the outcome. I willingly agree to follow all instructions and commit myself to attend all sessions without any exception. I also agree that I will
not disclose the contents of this course to anyone. I declare that I am physically and mentally able to participate in this program.

Date ____________________________ Signature ______________________________________

Place____________________________________________________________ Date__________________________________________

Personal Donation for Course NRs_____________________________________ Company Sponsored NRs________________________

Name of Instructor________________________________ Phone No _______________ Email ID ______________________________________

If you want to register yourself or anyone else in future please visit our website www.artofliving.org and register online and/or get all the
details you need.

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