top of page
Meditation

Begin Your PSM Journey

OM Yoga Events -

PRIMORDIAL SOUND MEDITATION

Application Form


Please complete all sections clearly. Your birth information is required to calculate your personal mantra.

PERSONAL DETAILS

BIRTH INFORMATION — Required to Calculate Your Personal Mantra

Date
Day
Month
Year
Time of Birth
Time
HoursMinutes

^ if unknown , leave blank, Suzi can assist

PREVIOUS MEDITATION PRACTICE

Have you previously been instructed in a mantra meditation technique?
Yes
No
Date instructed
Day
Month
Year

CURRENT HEALTH

AGREEMENT

My decision to learn Primordial Sound Meditation (PSM) is a personal decision. I have not been made any promises or warranties that I will receive any benefits or specific results. I understand that PSM is not a substitute for treatment or services ordinarily provided by health care professionals for physiological or psychological complaints. I further understand that any instruction given to me during the PSM is for me personally and may not be appropriate for others. In consideration for

teaching PSM, I hereby agree to hold the instructor, and their officers, agents, and employees harmless in any claims brought by me, or on my behalf, which contradict the above.

My signature below constitutes my acceptance of the conditions expressed in the agreement above.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Date
Day
Month
Year
bottom of page