Mystical Travels with a Yogi —2015 REGISTRATION FORM: Mystical Travels with a Yogi 2015 Name ofthe Yatra you ae attending: (ifboth, wite “Both Yatras’)__ Bory eee fee sjat! Srigh Your Legal Name (as printed on passport: _C=eh: gardo Antonio Moncada Spiritual Name, it Applicable: Ranvier S ngh Nationality: US Ae Email adcress:_MOnCada c Dhatmai]- cam Phone (HIS) BYS- 1402 Malingadcress:_1@(8 Fage Bt. CiyDay Faneseastate CA zipcode: 94/17 country: USA Date of birth: ol | 22/1454 _ Male [Mj/ Female [F]:_M\_ Passport No: _4INSSO1S9 Expected Date of Arriva: Det 30% Time: _[3D2 pra Expected Date of Departure; Dov _(€™ Time: _452 pm Emergency Contact ‘Who would you like us to contact in case of an emergency? Please provide a name, an email, phone number with the country code Name:__Mana€\eng Moncada Emai len. moncade Dhitmarl esehone_(UIS) 16-2742 Offerings for the Yatra are being send by: (tick the appropriate column) Cash when | arve:[_] By Cheque along this form: [_] By Telegraphic Transfer to CIBC Bank eects tig BER PA CTS Qerchecy Singh —Mystical Travels with a Yogi ~2015 WAIVER AND RELEASE OF LIABILITY 4. The person signing this agreement understand that Amandeep Singh and his representatives, organising this Yatra, are hereby released from any liability for any claims, obligations, damages, losses, injuries and/or causes of action arising as a result oftheir visit to Yatras. 2. The person signing this release further agrees and understands that we do not cover any insurance or liability about the safety and protection of the individuals and their possessions during their participation in this Yatra. 3. The undersigned agrees to notify the Yatra staff of any medical emergencies in advance, so that appropriate arrangements can be provided as required. 4, |understand that every effort will be made to sustain my well-being in an event of a medical ‘emergency, but | am stil fully responsible for obtaining any necessary insurance, medical treatment required on the trip, 5, The person signing this release understands that physical exercise is a part this Yatra and is at their ‘own risk for the exercise undertaken, 6. | accept the possibilty that Yatra staff or organiser will not be able to cover all program points outlined in the brochure due to unexpected restrictions, or unforeseen circumstances at the time and organisation. we have read and understood all of the above and sign this Registration and Release Form ‘Agreement, and release myself and on behalf of any minor children under 18 years designated below. Date: 2e1s- Place: San Frmasa, CA signature: Goal a rsa Name: A. Mincaole Names and age of any minor childrens: _ WA FOR OFFICE USE ONLY: Deposit Received: Initia: Date: Total Paid: