Apply for Badrinath A warm welcome to you for the Badrinath Yatra with Brahmarishi Mohanji 2017 pilgrimage! We sincerely request you to complete the following questionnaire. The answers will help us to organize your Badrinath Yatra in an effective way and serve you better. Please be assured that, your answers will be kept confidential. Badrinath Yatra Track (required) ---Badrinath with Brahmarishi Mohanji WITHOUT Valley of FlowersBadrinath with Brahmarishi Mohanji INCLUDING Valley of Flowers PERSONAL INFORMATION First and Last Name (required) Date of birth (required) ---01020304050607080910111213141516171819202122232425262728293031---JanFebMarAprMayJunJulAugSepOctNovDec---1932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619981999200020012002200320042005 Gender (required)MaleFemale Phone/Mobile with country code For e.g., +91 for India (required) Email address (required) Passport photo - only JPEG, JPG or PNG files < 2MB. Preferred format for filename (required) Mailing Address (required) Nationality (required) ---IndiaMalaysiaSingaporeHong KongJapanChinaUAEUSAUKCanadaAustraliaSerbiaRomaniaCroatiaMacedoniaBosniaRussiaHungarySpainGermanyFranceSouth AfricaNew ZealandOther Country of residence (required) ---IndiaMalaysiaSingaporeHong KongJapanChinaUAEUSAUKCanadaAustraliaSerbiaRomaniaCroatiaMacedoniaBosniaRussiaHungarySpainGermanyFranceSouth AfricaNew ZealandOther EMERGENCY CONTACT INFORMATION (Important) First and Last Name (required) Gender (required)MaleFemale Phone/Mobile with country code For e.g., +91 for India (required) Email address (required) Relationship (required) Mailing Address (required) Country of residence (required) ---IndiaMalaysiaSingaporeHong KongJapanChinaUAEUSAUKCanadaAustraliaSerbiaRomaniaCroatiaMacedoniaBosniaRussiaHungarySpainGermanyFranceSouth AfricaNew ZealandOther HEALTH CONDITIONS Do you have any major health problems including surgeries, genetic disorders or any kind of psychosomatic illnesses? If yes, please specify.(required) Are you taking any medications? If yes, please specify.(required) Do you have dietary restrictions? If yes, please specify.(required) D. PHYSICAL FITNESS Your physical fitness is important to face the adverse weather and altitude conditions during the Yatra. However, your conviction and faith will matter more. What is your Height (in cm) (required)? What is your Weight (in Kgs) (required)? What is your Blood Group? (required) How often do you exercise? ---DailyMore than once a weekOnce a weekIrregularNever How often do you practice Yoga? ---DailyMore than once a weekOnce a weekOccasionallyNever How often do you practice Pranayam (breathing exercises)? ---DailyMore than once a weekOnce a weekOccasionallyNever How do you rate your consistency in spiritual practices? LowMediumHigh GENERAL INFORMATION How did you hear about this program? (required) Have you ever participated in any other programs or activities of Mohanji Foundation or any other Master or organization? If yes, please specify what kind of activities and for how many months/years. What do you expect from this retreat? What do you hope to gain from it? Please provide your T-SHIRT SizeSMLXLXXL 7. SPIRITUAL JOURNEY AND DESTINATION Kindly write a short essay about your spiritual journey and what destination you hope to reach (minimum 200 words). Please note that there is no right or wrong answer. We simply would like to get to know you better. (required) NOTES AND RECOMMENDATIONS The region around the Badrinath with Brahmarishi Mohanji pilgrimage is known for its unpredictability due to sudden climatic changes at high altitude. This may adversely affect the pilgrimage and it is beyond the control of the organizers. We regret that, in such a case, the cost is not refundable. This Badrinath with Brahmarishi Mohanji pilgrimage involves short to medium treks on the mountains. We endeavour to reduce the amount of walking involved. However, the pilgrim will be expected to trek over 3-5kms at a stretch on a couple of days of the pilgrimage. We request the pilgrim to be prepared with the required physical conditioning for such activity. Your safety will always be our highest concern. Based on the health/medical details provided in your application form, the Badrinath with Brahmarishi Mohanji team may request you to furnish a provisional clearance from your doctor and/or, optionally, a go-ahead from your next-of-kin as a pre-condition for registration. Have you recently checked your hemoglobin? If not, please check it. Please consult your doctor and have supplements for iron, vit B12 and calcium for a month or two before the Yatra. If you have serious health conditions, we would recommend that you consult with a physician to help you take a studied call on your health condition vis-a-vis high altitude environments before you embark on the trip TERMS AND CONDITIONS I hereby confirm that I have personally filled all the information correctly and consciously, and I am carrying full responsibility for attending this pilgrimage. I take full responsibility for my physical condition including consulting with a medical practitioner to evaluate my health condition vis-a-vis high altitude environments should I feel the need or if I am asked so. I confirm that Brahmarishi Mohanji, Mohanji Foundation, any of the people or venues associated with Mohanji will bear no liability should any medical matter arise and I shall be financially responsible for any consequential medical, evacuation, accommodation or related expenses I hereby agree that Brahmarishi Mohanji, Mohanji Foundation, any of the people or venues associated with Mohanji shall not be responsible for any of the possible consequences related to the attendance to the pilgrimage. I hereby agree Brahmarishi Mohanji, Mohanji Foundation, including all organizers and assistants associated with Mohanji Foundation will not be held responsible for any loss or damage whatsoever and I waive all rights to compensation in case of injury or loss. I accept that Brahmarishi Mohanji, Mohanji Foundation, any of the people or venues associated with Mohanji will not be held accountable for any changes due to change of official rules and laws of Tibet. Moreover, I agree that they are not liable for any changes in the itinerary due to unavoidable circumstances such as landslide, road blockage, flood, snow, political unrest, cancellation of flight, sickness and accidents. I hereby agree to pay any extra cost arising due to the above circumstances on the spot. I understand that the registration is complete only after paying the full fee and that the contribution is non-refundable and registration is non-transferable. Likewise, any changes in the schedule of the program by the Mohanji Foundation will be notified in advance. In case of cancellation of the program, attributed to any cause that is beyond the reasonable control, including natural disasters like floods, fire, tempest or conditions caused by men, such as war, revolutions etc. the program charges will not be refundable. I welcome supporting Mohanji Foundation and its associates by enabling them to use my images, if necessary, and video footage in its publications and media placements. Should I wish to be excluded, it is my responsibility to inform Badrinath with Brahmarishi Mohanji organisers at the time of registration. DISCLAIMER I understand that the BADRINATH WITH BRAHMARISHI MOHANJI pilgrimage is challenging, in a variety of ways, including but not limited to the nature of the accommodations, the weather conditions, the size of the group and the journey itself. On this trip, I may be exposed to certain known and unknown risks, dangers, hazards and liabilities. In particular, I understand that there are certain risks inherent with this trip, including but not limited to the possibility of medical complications arising from the altitude, weather or travel conditions. I affirm that I am in good health and capable of performing whatever physical exercise or activity is required of me. I freely accept and fully assume any legal responsibility for any personal injury, death, losses, inconvenience or property damage that may arise from such risks, dangers and hazards as a result of my voluntary participation on this trip. I hereby agree to follow all rules, regulations, and instructions of the trip organizers while on this trip. I understand that the itinerary for this trip and the travel details are subject to change by the organizers, as needed to further the interests of the travel group at large. Mohanji Foundation has organized this trip on the clear understanding that it shall not be, in any way, responsible or liable for any accident, damages, loss, delay, international flight cancellation/delays, or inconvenience caused in connection with the travel facilities arranged. I agree to unconditionally abide by any decision MOHANJI MANAGEMENT (or) MOHANJI FOUNDATION may take in the event the trip be rendered impossible, due to unforeseen acts of nature, or any other unforeseen event or incident that renders it impossible for the travel group to make or continue the journey or if I am required to drop from the trip due to any act or omission on my part which in the Mohanji Foundation's view would amount to breach of the travel code of conduct, whether explicit or implied. Mohanji Foundation decision in this regard shall be final and binding. Mohanji Foundation reserves the right to modify any arrangements required by and made on behalf of the participants and to cancel the same without prior notice due to unforeseen circumstances. I understand that as this is a trip that is spiritual in nature, I may be asked to refrain from certain activities or follow certain prescribed spiritual practices; I agree to make my best effort to follow the recommended schedule and practice guidelines. I understand that as my experience will vary on numerous factors including my own actions; I cannot hold Mohanji Management, Mohanji Foundation, its volunteers, agents or those in active concert with them liable should I not be satisfied with my experience of this trip. In consideration of Mohanji Foundation allowing me to participate in this trip, I, on behalf of myself, my heirs, executors, administrators and assigns, hereby release, discharge, indemnify and hold harmless Mohanji Foundation, it's management, it's volunteers, tour operators, it's directors, employees, servants, agents and volunteers and each of their heirs, executors, administrators and assigns from any claim, cause of action, costs, attorneys fees, expenses or demands and all liability whatsoever arising or that may arise as a result of my participation in this trip due to any cause whatsoever, including negligence, breach of contract, or breach of any statutory or other duty of care, on the part of Mohanji Foundation, and further including the failure on the part of Mohanji Foundation to safeguard or protect me from the risks, dangers and hazards of the trip. Should emergency medical services become necessary for the undersigned participant, the expenses are the sole responsibility of the participant and not that of Mohanji Foundation. I hereby agree that Mohanji Foundation may use film or photographic records of this trip for its promotional and/or commercial purpose. This agreement shall be governed by and interpreted solely in accordance with the laws of India and no other jurisdiction. Any litigation involving the parties to this Agreement shall be brought solely within the state of Kerala, India and shall be within the exclusive jurisdiction of the courts of India. I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT PRIOR TO SIGNING IT/THIS AGREEMENT HAS BEEN READ OVER AND EXPLAINED TO ME IN A LANGUAGE I UNDERSTAND PRIOR TO MY SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, AND REPRESENTATIVES MAY HAVE AGAINST MOHANJI FOUNDATION. Please review if all mandatory questions are answered before you submit your application.