Affix photograph here

Affix photograph here

Registraon No: ___________Name: ___________________Venue: Janata Maidan, Nandan Kanan Road, Jay Dev Vihar, Bhubaneshwar - 751013Date : Saturday, 25 March, 2017Time : 9am - 1pm

Registraon No: ___________Name : ___________________________________________

To parcipate in your College / University Uniform -Blazer (if there is one) To be presenorthe enre duraon of the Youth Conference. Shall not be allowed to switch the workshop once selected Must carry your entry pass to gain entry to the Summit Must carry your Photo ID

Important for Registered Parcipant:

Queries & Registraons +91 9437115381 / +91 9861321270

| events@srisriyoga.in | www.ny.cc/odishayogmahotsav

Acknowledgment: Received Rs:

By Cash/DD:

Volunteer's Name: _________________________

Receiver's Signature: ________________________

Date:_/_/____

For Office Use Only

For Internal purposes:

Workshop Selected - _________________

For Internal purposes: Workshop Selected - _________________

ODISHA

YOG MAHOTSAVODISHA

YOG MAHOTSAVShikhar - The Youth Conference on Yoga 25 March, 2017 | 9am to 1pm

Janata Maidan, Nandan Kanan Road, Jay Dev Vihar, Bhubaneshwar - 751013

Appendix 1 - Registration Form

Registration closes March 20, 2017

Registraon per Parcipant: INR 300/- Payment* by Cash/ DD / NEFTFor Direct Bank Deposion / NEFT; Bank Account name: “VVKI ORISSA APEX BODY”; Account no: 024010100458719; IFSC Code: UTIB0000024; payable at Axis Bank, Main Branch, Bhubaneshwar For Demand Dra (DD) - in favour of - " VVKI Orissa Apex Body" Declaraon: I understand that whatever benefits I derive from this workshop depends on my parcipaon. I declare that I am of sound mental & physical health & am doing this workshop depends on my own volion. I will not hold VVKI, VVKI teachers, volunteers & its partners organizaon responsible for any changes that may occur in my life due to parcipaon in the workshop. The workshop contribuon is non refundable and non - transferable under any circumstances. I have read the terms & condion & agree to abide by them.

For Office Use Only: Received Rs. __________ INR By Cash / DD No. _________________ Dated: ________________________Drawn on Bank: __________________________________________________________ Date of Registraon: __ / __ / ______Volunteer's Name: __________________________ Mobile: _________________ Receiver's Signature: ___________________Queries & Registraon Contact: +91 9437115381 / +91 9861321270events@srisriyoga.in | www.ny.cc/odishayogmahotsav

_____________________Signature & Date

__________________________________________________________________________________________

Bhak Yog

Gyan Yog

Karma Yog

Raj Yog

Hatha Yog

In Order of your preference, number (No. 1 to 5) the following Breakaway Workshops, you want to parcipate in. (Selecon is only for one workshop)

The path of Devoon!

The path of Knowledge!

The path of Acon!

The path of Meditaon!

The path of Physical Purificaon!

*No refund on cancellaon

*No refund on cancellaon