Full Name Mobile
Email Address
Suburb Pincode
Date Of Birth (dd/mm/yyyy) Residence Phone No.
Organization Designation
Height in ft/inches Weight in Kgs

International Day of Yog

Please mention your current status

Yoga Student
Yoga Teacher
Remarks :

Mention your years of Yog Practice / Sadhana

Remarks :

Mention your Teaching experience in years, if any

Remarks :

Mention name of person who has invited you

New Age Yoga Institute
NAYI Teacher
Remarks :

Participant Declaration "I am registering for the Sahasra Shirsha Yog program on the occasion of International Day of Yoga on my own willingness and responsibility. I have been explained and I fully understand the program content . I undertake to practise the same, as prescribed from time to time by my instructor, at my own will, risk and discretion. I hereby declare my positive intention willingly to follow the program for my health benefit. I declare that I have informed New Age Yoga Institute of my health conditions for a presciption of program suitable for my health. I undertake further to inform my instructor at the venue of any change in my medical condition, if and whenever, it may arise during the program. I declare that I am not pregnant, nor have any illnesses, injuries, surgeries, pre-existing medical condition, nor taking any prescribed medication."

I accept
Remarks :
Follow Up Date (dd/mm/yyyy) Grand Total