Step 1 of 6 16% PERSONAL INFORMATIONName* First Last Email* Enter Email Confirm Email Phone Number* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth* MM slash DD slash YYYY Marital Status* Single Married Separated Divorced Widowed Gender* How did you first find out about this program?*Ananda.org websiteEmail(s) received from AnandaEmail(s) received from Expanding LightReferral from member of Ananda FamilyReferral from a friendWeb searchWebsitesSocial MediaConferencePrint AdRepeat EL GuestOtherIf “other”: ANANDA SPIRITUAL FAMILY SEVA PROGRAM INFORMATIONWhat are your preferred dates for participating in this program?* Have you ever participated in a program similar to the Ananda Spiritual Family Seva Program before?* Yes No If yes, please specify location and approximate dates* Have you ever stayed at the Expanding Light Retreat?* Yes No If yes, please specify which program and approximate dates Why would you like to be part of Ananda Spiritual Family Seva Program?*How are you involved with Ananda? Have you lived in an Ananda community? Are you a part of the Ananda Virtual Community or an Ananda meditation group, center or community?*Have you taken discipleship?* Yes No Are you a Kriyaban?* Yes No How have you served with Ananda in the past?*How would you like to help serve the Expanding Light Retreat? Please select your service areas of interest* Kitchen cooking – Help prep a meal or even cook a meal (Food handlers permit required; easy to obtain) Gardening/landscaping – Mowing lawns, weeding, planting, pruning Carpentry – Various projects such as building steps, painting the dining room, etc. Woodcutting – Bucking up logs and limbs around campus Daily or deep cleaning – Lahiri Mandir, Teaching Temple, kitchen, dining room, common bathrooms, etc. Housekeeping – Getting guest facilities (i.e. Seva, Harmony and Serenity Houses) sparkling clean Miscellaneous projects – Gravel paths, leaf blowing, various lightweight organizing, etc. Please let us know if you have any particular interests and or skills.*The Ananda Spiritual Family Seva Program is a more flexible version of the Ananda Karma Yoga Ashram Program. You are welcome to attend daily karma yoga events and activities as you feel to. Your experience on the spiritual path will be adding magnetism to the sister Ananda Karma Yoga Program. Are you willing to participate with a joyful and willing attitude during your stay with us ?* Yes No Daily service includes dishwashing (with heavy pots and pans) and housekeeping (cleaning bathrooms, vacuuming, etc.) and gardening. Will you be able to handle this in a responsible and energetic fashion?* Yes No HOUSINGAre you willing to share a small room with bunk beds with one other person (same gender) in our Karma Yoga housing? (Typically we cannot accomodate a private room)* Yes No Are you comfortable with sleeping on the top bunk?* Yes No Do you snore?* Yes No Would you be interested in bringing your own tent to live in during your stay (applicable May through October)?* Yes No Are you willing to commit to not using marijuana, recreational drugs, or alcohol either on or off the property while you are in the Karma Yoga Program?*We have a zero tolerance policy on this topic. Yes No TRANSPORTATIONDo you have your own transportation to the Ananda Spiritual Family Seva Program?* Yes No If not, will you be taking public transportation?* Yes No Please visit our website for more information about tranportation options: https://www.expandinglight.org/who/directions.phpDIET RESTRICTIONSDo you have questions or concerns about your diet? Please elaborate in detail. Important Note: Our kitchen offers a varied selection of vegetarian cuisine daily; we can provide dairy-free and wheat-free alternatives, but we are unable to accommodate all special dietary requirements.*MEDICAL INSURANCEYou must have Medical Insurance during your stay in the Ananda Spiritual Family Seva Program. Please provide your medical insurance information. If you do not currently have medical insurance we can refer you to a website to obtain travel insurance during your stay with us. Please bring your insurance card with you for your stay.Name of Carrier* Expiration date of policy* MM slash DD slash YYYY Policy number* Deductible* EL MEDICAL QUESTIONNAIREIt is very important that you answer the following questions completely and truthfully, as your physical, mental and emotional health are important factors in determining how our programs can best work for you. The Ananda Spiritual Family Seva Program requires that you participate in a variety of activities—some more strenuous than others. To help us decide if this program is right for you, please answer the questions below. All responses are confidential. Have questions? Please don’t hesitate to contact us at karmayoga@expandinglight.org.Please briefly describe your current overall health.*Please check any of the following difficulties you have had and explain relevant specifics in the next question.* Diabetes Stroke Seizures Eye condition Frequent diziness or falls Osteopenia-Osteoporosis Chronic Headaches Asthma Cancer Anxiety Depression Trauma Abuse PTSD Addiction Substance Abuse Insomnia Overweight Underweight Chemical Sensitivities Other None of the above Please explain the above health conditions you checked off in greater detail and with relevant dates.Do you have other limitations or health concerns? If so, please explain.* EMERGENCY CONTACT INFORMATIONIn case of an emergency, whom can we contact?Name* First Last Relationship* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone* I hereby certify that the above information is correct to the best of my knowledge, and I will continue taking all medications as prescribed by my health care practitioners(s) while in Ananda Spiritual Family Seva Program. (Please sign your name)* During your participation in the program, we will be taking photos and videos for marketing purposes. Do we have permission to use any photos and videos of you?* Yes No 21188Δ
