(Confidential) ae 24 Roctit No ‘THE ART OF LIVING: WAI VIKAS KENDRA (INDIA) Fotomate a THE ART OF LIVING HAPPINESS PROGRAM (Plone we CLEARLY aid in BLOCK LETTERS) Name. n [ Forale Home Addross. State Pi, Ofce Adress. State Pin. Phone (Ri). soe (O) . (Mobie). OMA svn DaN@ of Bh. Profession. ‘Specialisation. 1 Are you experiencing any ofthe following heaith conditions [Asthma Epilepsy I. High Blood Pressure [_ ] Heart Conditon [Back Pain ried 9 Ber tiese [Tuberous Others (Pieaso spect) A i 2A you curenty aking any proscribed medications? [10 [ INo I yes, please explain, 3. Have you ever undergone Psychiatric Trestment? [1¥es[ JNo If yes, please explain 4. Please any ihe programme inthe fk of soli development you have parcipatedintaughtyourret? 5. How did youFindoutabout"The Artof Living" course? Declaration ‘am parscogingn “THE ART OF LNG” pogrene my sulk spe paripetrg hs pogrne | SEIS eRe Sere one rues errata ema zene os Heeranne ils oy otaniodlhsefon ous en hartens hay toned BR SRIRAN ERAN Date, Course Date, Sia — = : i ‘ThisinaPrevegiraSon Acnowiedgement Oficial Receiptor this donation wouldbe issued during the course, Received the sum of Re, From SmiSh being the ‘conten fr "The Artof Living Happiness program” course lobe conducted by forthe parod. to attnovonve Visite us at: werartotving orp ne