Tat Tvam Asi

(An Indian Public Charitable Trust for the furtherance of Dharma Moksha)

Regd Off: ‘Ashirvad’, 2/507, III Cross St, Sunrise Avenue, Neelangarai, Chennai – 600 041, India

USA Center: Mr. S.M. Kumar, No.1135, Anolas Way, Lutz, Florida-33548, USA.

Registration form: ‘Tat Tvam Asi Meditations’ (Spiritual Retreat)

Date & Time: Oct3rd4th (Sat 9:00 am to 6:00 pm & Sun 10:00 am to 7:00 pm), 2015

Venue:Marshall Student Centre, 4202, East Fowler Avenue, MSC 2708, Tampa, Florida 33620

Tel: (813) 868-7770, Fax: (813) 868-7771

Email:

Organizer: Tat Tvam Asi Representative, Mr.S.M. Kumar, Cell/Mob:813 679 4237

Name :

Name (short form):

Address :

City:State:Postal Code:

Country :

Home Phone :Cell/Mob Phone:

Email :

Date of Birth : Sex: Female Male

dd /mm/yyyy

Height :Weight :

Marital Status : Single Married Partner Divorced Widow/Widower

Children : Yes No Number

Occupation:

Educational Qualification: Humanities Arts Sciences/Technologies

High School Graduate Post Graduate Research degree

Physician’s/Surgeon’s Social Work/NGO Religious Spiritual

In case of emergency contact:

Name: ______Phone: ______Relationship: ______

Address: ______

Diet Style: Veg Non-Veg Vegan (No eggs, milk, milk products)

Any Food Allergies?:

Do you smoke?: No Yes

Presently on medications?: No Yes

Any chromic physical/mental illness/dysfunction? No Yes, If Yes, Please specify briefly ______

Have you undergone psychotherapy in the past? No Yes

From ______To ______

Name & Address of Therapist:

Have you ever been hospitalized for mental illness or mental breakdown?

Yes No, It Yes, Please give details of diagnosis treatment.

Have you ever had a seizure? No Yes

Do you have epilepsy No Yes

Activities that give you joy:

Activities that are repugnant to you:

Any other spiritual retreats / meditations you have attended?

Are you affiliated to any religious/spiritual organization?

What has motivated you to participate in Tat Tvam Asi Meditations?

What benefits have you already received?

Would you like to share any other important info with us?

Your religious affiliation: Hindu Christian Islamic Sikhist Jaina
Zorastrian Buddhist Judaic Bahai Shinto Taoist Other Faiths/Masters

Your philosophical / spiritual / disposition/path:

Theistic

Atheistic

Agnostic

Philosophic

Mythic

Yogic

Astrologic

Philosophic & Scientific

Humanistic

Psychic

Psychologic

Religious-Scriptural

Religious-Though Masters

Religious-Through Practices

Registration & Course fees: $300/-for an individual ($500/-, for a couple, $150/-, for a student). This is inclusive of lunch on both dates & two refreshments/day.

Participation through Scholarships and by Invitation :

Tat Tvam Asi also offers partial / full scholarships to deserving mumukshus. Sometimes Tat Tvam Asi extends an invitation to participate in its retreats/programmes on the basis of meritorious spiritual, social or professional credentials.

Tat Tvam Asi Mission

W.e.f. 2011 Tat Tvam Asi retreats have been conducted in Chennai (this is the fourth, others in 2011, 2012), Toronto(Canada), Punta Del Este (Uruguay), Santiago (Chile), Chillian(Chile), Brasilia(Brazil) Mexico City(Mexico). In these retreats, meditations, Sankara Bhagavadpada, addresses the complex problem of the inner suffering in human lives on the basis of his own realizations & through the means of the Vedic/Hindu sacred teachings (Atma Jnana, Jyotir Vidya).Through these means, heseeks to bring liberation and relief from these sufferings – thus nurturing ‘Loka Kalyana’ (World Welfare) at a fundamental level. The retreats firstly purify our consciousness & thereby ‘awaken intelligence’. As a consequencein the sequel to this ‘awakening of intelligence’, there arises the true discovery of the Divine through heightened awareness, study of scriptures & intelligent living. Thus the goal is union with the Divine (Source) and this is spiritual fulfillment in life. Results will depend on dedication, intensity of participation & blessings of the Divine, based on good karma.

Terms & Conditions (Participant’s Statement):

In the light of the above mission of Sankara Bhagavadpada,the trusteesrepresentatives of Tat Tvam Asi, and in consideration of the mutual benefits which are expected to arise out of my participation, under the aegis of Tat Tvam Asi,
I hereby release forever and discharge Tat Tvam Asi Trust/ and all trustees, representatives and successors of Tat Tvam Asi, from all claims & demands which
I, my heirs, executors, administrators and assigns have, or may have against them by reason of any physical injury & mental emotional issue of any nature whatever, which I might suffer duringand after my participation in their retreats/programmes and
I hereby expressly declare that any such participation is entered into by me voluntarily in an effort to increase my knowledge about myself(the self) and the Divine.

I agree to the above terms & conditions certify that the answers given by me on this application are true & complete to the best of my knowledge.

Participant’s Signature:

Dated:

Note on Confidentiality: The information you have furnished here will be used by the trustees and organizers only to understand your difficulties and your personalities and to enable you to effectively participate in the retreats/programmes.The strict confidentiality of this information will be respected by the trustees / representatives / organizers of

Tat Tvam Asi.

______

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