+91 9947 271514 ayuryogakannur@gmail.com Application Form

Application Form

About this form

    PERSONAL DETAILS

    Select Course/Retreat/Program



    HEALTH INFORMATION


    The following questions are here to help us to provide each participant with the nessesary means to make the program more beneficiable. The answer to these questions will be kept in strict confidance

    Are you currently taking medicines for any physical or psychological conditions

    Do you have any chronic physical limitations or disabilities

    Do you have a communicable disease

    Have you had a serious illness or major surgery within the last five year

    Are you currently pregnant or trying for pregnancy

    You are required to pay a registration deposit to reserve your space.The balance fee should be paid upon arrival or before check out. We accept the initial Course Fee Registration deposit through Credit Cards, Paypal or Bank (wire) Transfers.