‘Mystical Travels with a Yogi ~ 2015 REGISTRATION FORM: Mystical Travels with a Yogi 2015 Name ofthe Yata you are atencng (tbo, wate “Both Yates) pAeAS Single Accommodation: Double Accommodation: -f c ele RED. ‘Your Legal Name (as printed on passport; _ PUSAN une fhuckland Spitual Name, if Appcabe: ~ Ante fl&m ae atonatty,_ AA Vera. Email address: Q phone _OUAS~ BAD-03 6 Mailing address: 10% ani SE oy, ASAI _ state 1510. Zp cote: TAD counny Aven AULA Date of birth: gluls¢ Male [M] / Female (FI: Passport No: expected Date ot anvat JON time: 1B A ee SAN re Ef Emergency Contact rrr outa ut eatin case of an emergency? lease provide arame, nel prone Se oat os wane. ane Bocveand . Email prone OUD 900 132 Offerings for the Yatra are being send by: (tick the appropriate column) ‘Cash when | arrive: By Cheque along this form: By Telegraphic Transfer to CIBC Bank: (oe tate FQ Nnamdi Y (bp 2 > Zs g farenslowr (peasooed Mo