Ved Vignan Maha Vidya Peeth

Gali No. – 13, Sheesham Jhadi, Muni Ki Reti – 249137, Rishikesh, Uttarakhand
(Programme Registration Form)

S. No. …………. Receipt No. ………………………….

Receipt Date. ……………………….
Room No. ……………
Name: ………………………………………………………………………………………………………………… M F
Address: ………………………………………………………………………………………………………………………………………………………..
City: ……………………………………………….. State: …………………………………………………….. Pincode: ………………………….
Mobile NO.: ………………………………………………. E-mail: …………………………………………………………………………………….
Age: ……………………… DOB: ………………………………………… Occupation: ……………………………………………………………..
Program Name: ……………………………………………………………………………… Room Sharing: …………………………………….
Arrival Date: ………………….. Arrival Time: ………………… Dep. Date: ………………………. Dep. Time: …………………..

Do you have any health problem(s)? Yes No

If, Yes Please specify: …………………………………………………………………………………………………………………………………….

Please give a phone number I case of emergency: ………………………………………………………………………………………..

Payment Details: Amount Rs. : …………………………………………………….. Online Card Cash
Ref. No. / Transaction ID: ………………………….…………………………….……… Bank ……………………….. Date…………………
PAN No. (Mandatory): …………………………………………………………………………………………………………………………………
Date & Place when you completed AOL Happiness Program: ………………………………………………………………………..
You Happiness Program Teacher’s Name & Teacher Code: ……………………………………………………………………………

Are you an AOL Teacher? Yes No Part Time Full Time

Your Teacher Code: ……………………………………………. AOL Programs you teach: ……………………………………………….

Declaration: I hereby declare that the above information given by me is true. I am participating in
this AOL Program on my own and I take full responsibility for participating in this Program. I release
Ved Vignan Maha Vidya Peeth all Organizers Coordinators and Assistants of this Program from all
damages whatsoever & waive all rights to compensation. I declare that I am physically and mentally
fit and able to participate in this Program. I undertake that I will not teach any of technique of this
Program unless I have been fully trained by His holiness Sri Sri Ravi Shankar Ji. I have read the AOL
circular and agree to abide by all rules & regulations.

Date: ……………………… Signature