Form- 3S Program Registration

3S Program Registration

Yes! I want to Enroll for 3S CLASSES

3S – The New Science of Sustainable Happiness-Smart Learning System classes

Class Location :.

Beginning Date :

Class Timing :

Name :

Birth Date :

Gender : MaleFemale

Address :

Education :

Profession :

Phone :


Current Exercise / Yoga / Meditation Practice: (If any) (Information provided will remain CONFIDENTIAL)


1. Any previous exercise / yoga / meditation training? :

2. I prefer exercising (select one or more) : StandingSittingLying downCombination

3. Any previous Pranayama or Reiki training? :

4. Types / Techniques regularly practiced (items 1/2/3/4)? :


5. How long have you been practicing? :

6. Time of day & duration of yoga / meditation / exercise? :

7. How often (daily, weekly)? :

8. How long can you comfortably sit during meditation? :

9. Are you comfortable sitting on the floor?

How long?

10. Specific physical / emotional / health / relationship concerns that you wish to overcome or dissolve?

a. Physical :

b. Health :

c. Emotional :

d. Relationship :

Course Duration : 1 Month2 Month3 MonthRetreat / Shibir

Jinendra also offers personal guidance and counselling by prior appointment.

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I have read and agree with the terms and conditions