Dr Mr Mrs Miss
Name of Applicant	:
Father's Name Husband's Name	:
Date of Birth (dd/mm/yyyy)	:
Nationality	:
Full Address	:
Telephone No.	:
Cell No.	:
Email	:
Qualification	:
Medium	:	Hindi English
Additional Qualification	:
Experience (if any)	:
Affiliation	:	Affiliation Letter
Treatment Centre Name	:
Treatment Centre Address	:
Mode of payment of fee	:	Money Order Demand Draft Cheque
Attach your Photograph	:
Declaraion of the applicant
The content of the application form that I have submitted are true to the best of my knowledge. If any statements given by me will prove false, I will be fully responsible, and I stand disqualified.
Please enclose the following Documents:
Two-passport size photos Xerox copies of Mark-Sheet & Certificates Date of Birth Certificate Character Certificate

If you wish to have a colourful laminated Identity Card from Our Institute with your personal Registration No., Including fields in which you are working, complete address of your centre, Phone no. and your Photo. Then fill the following form. The fees for colourful laminated Identity Card is Rs. 250/- only (For Indians) or $10 (For Foreign Candidates)
For Identity-Card
Name	:	Dr Mr Mrs Miss
S/o D/o W/o	:
Phone No.	:
Mobile	:
Fields in which you are interested to work	:	Acupressure Magnet Reiki Pyramid Vaastu Sujok Naturopathey Yoga Feng Shui