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Registration Form
Harinama / Brahmana Diksha
Please fill the form carefully with correct information.
Full Name:
Date of Birth:
Gender:
Male
Female
Email Address:
Mobile Number:
Alternate / WhatsApp Number (optional):
Present Address:
City:
State:
Country:
Pincode:
Contact:
Permanent Address:
Same as Present Address
City:
State:
Country:
Pincode:
Contact:
Education:
Occupation (if working):
Are you a Brahmacari (staying in the temple)?
Yes
Marriage Status:
Select from below
Single
Married
Divorced
Name of Spouse (if applicable):
Spouse's KC Status:
Select from below
Devotee (practicing KC & chanting)
Favorable to KC
Neutral to KC
Unfavorable to spiritual life
Name of Children and their Date of Birth:
Are you connected to a temple?
Yes
No
Name of the Temple (with city):
Devotional Services that you are rendering:
Guiding Devotee:
Guiding Devotee's Phone:
Guiding Devotee's Email:
Applying for Harinama Diksha OR Brahmana Diksha?
Harinama Diksha
Brahmana Diksha
You have been in touch with Krishna Consciousness since ____ years:
Chanting 16 rounds since ____ years:
Following 4 regulative principles since ____ years:
Have you completed ISKCON Disciple Course (IDC)?
Yes, I have the IDC certificate.
No
Have you completed the GBC Harinama initiation philosophical exam?
Yes
No
Harinama Diksha Name:
Harinama Diksha Guru's Name:
Date of Harinama Diksha:
Have you completed Bhakti Shastri Course (BSC)?
Yes, I have the BSC certificate.
No
Have you completed the GBC Brahminical initiation philosophical exam?
Yes
No
Do you have the recommendation letter from temple president/official authority (it is required if you are taking Diksha either from Vrindavan or from temple other than the one you are connected to)?
Yes
No
NA
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