No.

60/4, 17th Cross, Between 4th & 6th Main Malleswaram, Bangalore - 560055, India Contact: +91-990-004-5199, mail@nadichikitsa.com

Nadichikitsa.com

Name:

Age:

Sex: M

F

Address for Communication:

Phone/Mobile:

Occupation: Vaidya (Ayu) Vaidya (Sid) Doctor(Mod) Yoga Therapy Others Doctor(Hom)

Acupuncture / Acupressure

I am interested to learn Nadi Pariksha because:

I have deposited a cheque in ICICI Bank for Rs. 10000/- (Rupees ten thousand only) favouring Mahesh K bearing Account No. 625301512013. Cheque details are enclosed below; Cheque No. Dated: Con rmation to the workshop is subject to realisation of cheques. I hereby acknowledge that all the above stated information is true to the best of my knowledge.

Email:

Signature with Name and Date

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