| Course Name: |
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| Course starting from : | |
| Your Name(Last/First): | |
| Date of Birth(dd/mm/yy): |
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| Gender: | |
| Student's Current Occupation : | |
| Parent's/Spouse Name : | |
| Parent's/Spouse Occupation : | |
| Permanent Postal Address: | |
| City: | |
| State: | |
| Pin: | |
| Country: |
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| Student E-mail ID (s): | |
| Telephone Nos: | |
| Emergency contact name & tel. Number: |
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| Health status : (Please write past history and present status of any serious health conditions:) |
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| Educational Background : |
| Qualification Degree Name: | Name of Institute/ School/College/University/ |
| 10th | |
| 12th | |
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| Do you practice yoga? |
| if, yes then for how long? |
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| Do you teach Yoga? |
| if, yes then for how long? |
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| Why do you want to do course with us ? | |
| Work Experience : |
| (If You are a fresher , write N.A) Most recent job/activities | |
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| Security Code: |
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| Declaration by the student:
I am participating in above program on my own and shall follow the general rules of the institution and instructions of guides /teachers/staff and shall not claim whatsoever against them or the institute and relieve them for all responsibility & liability. The student hereby allows Institute to use his/her name/photo in various communications. |
| Payment :
Check or Cash or Wire For Wire Please make wire in our Institute’s following account:
Name of the Beneficiary Account : Paramanand Institute of Yoga Sciences and Research
Address of account : Khandwa Road, Near NDPS, Indore (MP) 452020 India
Bank: HDFC Bank
Address of the Bank: Trade House, South Tukoganj, Indore, India
Account Number: 00362560009661
International Swift Code : HDFC INBB
(First email us completed application and then inform us wire transfer details.)
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