The information will launch you on instructions to put you in charge of the quality of your life and health through self-recognition.

Please select the course for which you are filling out this form.

  1. Understanding Biotic Space ($50.00)
  2. Biotic Space Exercises ($100)

Name (please print legibly):


E-mail address:

Address (optional):

Are you a vegetarian?

  1. yes
  2. no
  3. partial

Are you spiritual/holistic in your outlook on life?

  1. yes
  2. no
  3. not really
Your phone number (optional):

How do you regard yourself? (mark as many attributes as you like)

  1. teacher
  2. student
  3. artist
  4. altruist
  5. questioner
  6. parent
  7. protector
  8. giver
  9. taker
  10. curious
  11. self-motivated
  12. thinker
  13. understanding
  14. liberal
  15. practical
  16. leader
  17. follower
  18. serious
  19. difficult
  20. forgiving
  21. selfish
  22. careful
  23. carefree
  24. friendly
  25. cultural
  26. private
  27. secretive
  28. dependable
  29. mechanical
  30. self-starter
  31. decisive
  32. doubter
  33. sincere
  34. procrastinator
  35. professional
  36. generous
  37. tight-fisted
  38. jolly
  39. lucky
  40. critical . . .

Please follow a scale of 1 to 10 (1 is low . . . 10 is extremely high) to rate yourself for the following items.

Your sense of aggression:

Your sense of stress:

Your sense of peacefulness:

On the same scale, show how well you can concentrate on learning a new concept:

Once you start on the course, continuity is important. Can you commit half hour per day for your well-being?

  1. yes
  2. no

Please mark ONE concept you feel at home naturally

  1. Mountain
  2. Stream
  3. Tree
  4. Unity
  5. Duality

Please make a selection for Ayurvedic Health program.

I realize that I am providing this self-assessment volantarily, because I want to improve my family's spiritual, mental and physical well-being.

Please state what you would like to achieve for yourself.

Your goal:

Be proud that you have taken the first step!

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To place order Click here

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