Shree Vidya Level III Form

(GOA)
Hindi Language Shivir (5
Name (in Capitals):

______________

_______________

(First)

(Middle)

(Surname)

__________

(DOB: dd/ mm/ yyyy)

(Gender: M/ F)

PERSONAL

th

13 June 2012)

____________________

________________

Home Address:

th

____________________

______________________________________
________________

______________

(City)

(District)

_
(State)

Contact Details:

Paste
Recent
Coloured
Photograph

(Marital Status)

___________
(Country)

(PIN Code)

____________

_____________

_____________________

(Mobile #)

(STD and Home Tel#)

(Personal Email ID)

Occupation:

_____________________

Profession:

______________________________________________________________

Designation:

_____________________

Name of Organization: ______________________________________________________________

SHIVIRS

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Place

Month & Year

Shambhavi / Shree Vidya-I

____________________

___________

Shree Vidya-II

____________________

___________

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1. Have you taken any Mantra Deeksha or Guru Deeksha?

Yes / No

a. Name of your Guru ____________________________________________________________

Other Information

b. Name of the path or organization _________________________________________________

c.

Are you practicing any Sadhna taught by your Guru?

d. How much time do you daily practice this Sadhna?

Yes / No
___________________________________

e. Are you connected with any Seva projects? Please specify capacity in which you are associated.

_______________________________________________________
f.

How long have you been associated with the organization? ____________________________

2. Are you facing any problems in the areas below?

a. Health _________________________________________________________
b. Financial ________________________________________________________
c. Social / Family / Relationships __________________________________________
d. Any other ________________________________________________________
3. Have you felt any changes in your life after joining Shiv Yog?

Yes / No

H.O.: Shree Vidhya Infinite: D-170, Sector 8, Dwarka, New Delhi-110 075.
Tel. Nos.: 9811016531 / 9999985961/62/63
website: www.shivyog.com
email: info@shivyog.com



a. What improvements have you seen in your own growth, since you have joined Shiv Yog?
________________________________________________________________

_______________________________________________________
b. Specify any benefits that your family may have had since you have joined Shiv Yog?

________________________________________________________________
Other Information

_______________________________________________________
4. Are you facing (or have faced in past) any legal proceedings under any Indian regulations or that of any
other country? If yes, please provide details below:

_____________________________________________________________________
_____________________________________________________________________
5. Briefly describe any professional expertise that you have, to contribute towards Seva projects in Ashram.

___________________________________________________________
___________________________________________________________
a. What in your views are the weaknesses of the Shiv Yog Foundation?

________________________________________________________________
b. What are the changes you feel should be incorporated in the foundation?

_______________________________________________________

Referenc
es

c. How can you help the foundation to improve? (Your personal Seva / Contribution)
________________________________________________________________
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Any references of Shiv Yog Sadhaks:
Name:
Address:

_________________________
Contact Number: _________________________
_______________________________________________________________________

Declaration

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I, _________________________, hereby confirm that I am participating in the Shiv Yog programs
at my own will. I take full responsibility for participating in this program, and its outcomes
whatsoever. I will maintain the sanctity and keep the contents / proceedings of the program
confidential. I will maintain the discipline in the program, and I understand that if my conduct is
found to be inappropriate, I may be asked to vacate the premises and refused further admission in
the program.

Date: _____________

Place: _____________

Signature: __________________

Payment

Important Note:
1) Use of mobile phones is strictly prohibited inside the venue.
2) Any form of digital recording is not allowed.
3) Registration amount is non-refundable and non-transferable.

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Registration Amount : ________________________
Payment Option:

Cash

DD No.: ______________

Receipt No. : _____________________________

DD (DD should be made in favour of Shree Vidhya Infinite, payable at New Delhi)
Dated : ______________

Bank : _____________________________

H.O.: Shree Vidhya Infinite: D-170, Sector 8, Dwarka, New Delhi-110 075.
Tel. Nos.: 9811016531 / 9999985961/62/63
website: www.shivyog.com
email: info@shivyog.com