SATKHOL APPLICATION FORM

(Kindly note that all mandatory fields (marked with *) are to be filled in.

IMPORTANT: Please ensure Email IDs are spelled correctly. Incorrect email addresses will delay registration process.

Personal Information

Center*
Primary Contact Name*
Address Line 1*
Address Line 2
City*
State*
Postal Code*
Country*
Phone (with STD code)
Mobile
Email ID*

Other Information

Please select from the list of available batches to indicate your choice of batch for visiting Satkhol, in the order of preference.
Batch Choice 1*
Batch Choice 2
Batch Choice 3
Batch Choice 4
Batch Choice 5
Authorization from Preceptor / Centre-in-charge is essential. Please enter relevant particulars below. Plase make sure Email ID is correct.
Preceptor's Name*
Preceptor's ID Number*
Preceptor's Email ID*

APPLICANTS

Sl. No.	Name*	Age*	ID Number*	Date of Joining in DD/MM/YYYY format	Male	Female
Applicants between 5 to 65 years who wish to travel to Satkhol. Children under 5 are not permitted. IMPORTANT: Children should be included in the application form at the time of registration. Inclusion of children later will not be possible. Satkhol facilities are designed and are conducive to retreat into silence with oneself. Based on observation and feedback from participants, it is in everyone's interest if you did not bring your children (less than 15 years) to Satkhol.
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Kindly note that the forms will be accepted as long as the space is available.
Approval Status along with allotted batch will be intimated to the Preceptor and the center-in-charge.
All queries to be marked to satkhol@srcm.org