VISHNU BHARATH YOGA KAKAI KOODAM

VISHNU BHARATH YOGA KALAI KOODAM

(YOGA TRAINING CENTER)

¡¡¡¡¡¡

¡¡¡¡¡¡APPLICATION FORM

(ALL DETAILS KEPT CONFIDENTIAL)

Regn. No. : .......................................................................

Date of Regn : ......................................................................... Name : .........................................................................

Address : ........................................................................

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Telephone (Res)........................... (O)....................................

Cell........................... E-mail.................................

Occupation : ...........................................................................

Sex/Age/Date of Birth : ..........................................................................

Height ..................................... Weight .................. Blood Group .............

Membership : Monthly Quarterly Half yearly Annual

Individual

Family

Group

Donation* : ........................... Class..................................

Medical History if any : ...........................................................................

Do you have any previous

Yoga experience ? : .......................... How long? ......................

How did you come to

Know about me? : ........................ Source ...............................

Are you already in my

Mailing list : ...........................................................................

Purpose of joining the

Course : ...........................................................................

*Not Refundable

To the best of my knowledge the information given above is correct

Signature of Member

Place :

Date :

Yoga Therapist N.K. Marudha Muthu, No. 40/103, Rajangam Middle St, Kumaran Colony, Vadapalani Chennai-26.

Ph: 044-2362 4793 Mobile: 98410 72688 E-mail: yogamuthu99@yahoo.co.in website: www.vibhayoga.org