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Registration Form
Harinama / Brahmana Diksha
Please fill the form carefully with correct information.
Full (Legal) 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 Krishna Consciousness (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:
Name of the Temple you are connected with:
Devotional Services that you are rendering:
Guiding Devotee's Name:
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
Diksha Date & Location:
Select from below
1-Dec-2025, Agra
2-Oct-2025, Bahudargarh
5-Jun-2025, Mira Road
9-Jun-2025, Khargar
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
Not required (Diksha at local temple)
Leave this field blank:
Captcha:
Submit
Srila Prabhupada ki jaya !
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