Tantra Event Application
Name(s):_____________________________________________________________________________
Address:_____________________________________________________________________________
Telephone:
(....
)__________________
E-Mail: ______________________
Age(s):________
Sex(s):________
For Swami Virato to better know you
please complete the following:
Voice Greeting by Swami Virato
Which of the following have you experienced: (Check
all that apply. If you do not know of a
word or phrase just put a ?)
|
__ Yoga |
__ Est |
__ Lifespring |
__ Gestalt |
__ Silva Method |
__ Tantra |
| __ Jail/prison |
__ Insight Training |
__ Meditation |
__ Primal |
__ Rebirthing |
__ Aerobics |
| __ Trance Dance |
__ Massage |
__ Swinging |
__ Breath work |
__ Encounter |
__ Raped |
| __ Group sex/orgy |
__ Psychotherapy |
__ Osho group |
__ Psychodrama |
__ Incest |
__ Marriage |
| __ Masturbation |
__ Oral sex |
__ B & D |
__ S & M |
__ Bestiality |
__ Zazen |
| __ University |
__ Attachment |
__ Christianity |
__ Moslem |
__ Jealousy |
__ Depression |
| __ Overweight |
__ Pranyama |
__ Being Drunk |
__ Fantasy |
__ Homosexuality |
__ Bisexuality |
| __ Being a Rapist |
__ Pedophilia |
__ Vegetarian |
__ Bipolar |
__ Rage |
__ Wicca |
| __ Magic mushrooms |
__ Cannabis |
__ Cocaine |
__ OBE |
__ India |
__ Quodoshka |
| __ Fundamentalism |
__ Obesity |
__ Mood Swings |
__ LSD |
__ Loneliness |
__ Dependency |
| __
any other self-help, new age,
metaphysical,
psychological, physical, ritual, cult, spiritual or transformational descipline(s), event(s)
or unusual or extraordinary traits, habits or behavior(s)? Describe: _________________________________________________________________________________________ |
_________________________________________________________________________________________ |
Have you attended a Tanta workshop?
___Yes, No___
(If yes, when, and with whom?)
Which best describes you?
(check all that apply. If you do not know
a word or phrase place a ?)
| __ Very conservative |
__ Somewhat conservative |
__ Somewhat liberal |
__ Very liberal |
| __ Totally wild |
__ Shy |
__ Outgoing |
__ Promiscuous |
| __ Monogamous |
__ Jealous type |
__ Overweight |
__ Spiritual |
| __ Angry |
__ Fearful |
__ Overpowering |
__ Boring |
| __ Polyamorous |
__ Addictive Personality |
__ Quick tempered |
__ Weak willed |
| __ Spacey |
__ Humorous |
__ Flirtatious |
__ Sexy |
|
__ Other
(Describe) _________________________________________________________________________________________________ |
Describe yourself in your own
words:
.
.
How do you define
"spirituality?"
.
What is sex?
.
What do you know of Tantra?
.
Have you had any mystical
experience(s)? __No __Yes (describe):
.
Do you have any physical or psychological
handicaps or problems (bad back, heart condition, epilepsy, depression,
mania, phobias, allergies, addictions, STD, etc?) __Yes, __No
If yes, or other, describe:
.
Are you currently under the care of
a physician? __ Yes, No__
(If yes, please provide his/her name and telephone number)
Check Event You Wish to Attend:
(US
rates. For foreign rates contact local sponsor)
| .Event
Name |
.Fee |
Date(s) |
Location |
| ___ Tantra Retreat |
$295/m-f couple |
__________ |
____________________________________ |
| ___ Theatre Tantra |
$395, $595/m-f couple |
__________ |
____________________________________ |
| ___ Cosmic Love Event |
$250, $395/m-f couple |
__________ |
____________________________________ |
| ___ Evening Event |
$ 35, $ 55/m-f couple |
__________ |
____________________________________ |
| ___ One Day Event |
$ 95, $165/m-f couple |
__________ |
____________________________________ |
| ___ Tantra Party |
$ 50/m-f couple |
__________ |
____________________________________ |
| ___ Private Consultation |
$100, $125/couple |
__________ |
____________________________________ |
Please
refrain from using any perfumes prior to an event (this includes
perfumed soap, deodorant, hairspray, after shave, etc.,).
Do not use any mind-altering substances (including but not limited to: marijuana, LSD, alcohol,
cocaine, tranquilizers, etc.) for 7 days before an event. We also ask
that you refrain from using any meat products, garlic or beans for at
least 1 day before and event.
Have a clean body and breath. |
Send this form by postal mail with your check or m/o
to:
Nepal Institute, PO Box 17397,
Asheville, NC 28816
(828) 230-9627,
e-mail
|