STHITAprajna- Vegan Life Centre

REGISTRATION FORM*

(send separate form for each participant)

1. Name:

2. Address:

3. Country:

4. Email:

5. Telephone No.:

6. Sex: Male/Female

7. Date of Birth:

8. Date of Arrival:

9. Date of Departure:

10. Package Desired: (select one package plus single supplement charges if applicable)

a. Package 1: Rs.4000 for Resident Indians (US $ 100 for others) -------------------

b. Package 2: Rs.7000 for Resident Indians (US $ 175 for others) -------------------

c. Single supplement charges (package 1-25%, package 2-50%) -------------------

Total -------------------

11. Siganture:

12. Date:

Payment may be made directly to the hotel. Please contact us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it for mode of payment.

*Send this form as an email attachment in .doc format.