INTERNATIONAL SOCIETY FOR KRISHNA CONSCIOUSNESS

Founder-Acarya: His Divine Grace A.C. Bhaktivedanta Swami Prabhupada

HH LOKANATH SWAMI MAHARAJA
DISCIPLE DATA FORM (official)
Radha Govind Dev Temple, ISKCON Noida, A-5, Agrasen Marg, Sector-33, Noida, Uttar Pradesh 201301, INDIA
Krishnabhakta Dasa Mobile: +91 9654209343 email: krishnabhakta.Lok@pamho.net
Dinanukampa Dasi Mobile: +27 827033980 email: dinanukampa.LOK@pamho.net
Padmamali Das Mobile: +91 8980636683 email: Padmamali.LOK@pamho.net
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□ Harinama Diksa □ Brahman Diksa

Please stick
Spiritual Name:
your passport size
Date of Initiation: / / color photo here

Place of Initiation:

How can you contribute to the Srila Prabhupada’s Movement?

Which of your skills/hobbies/talents are being used in the service of ISKCON?

Which skills would you like to acquire in future for the service of Lord ?

What devotional services are you rendering?

Your Counselor’s name:

PERSONAL DETAILS:

First Name: Last Name :

Date of Birth: Nationality:

E-mail: Mobile number:

Address :

Civil Status: □ Single □ Married □ Brahmacari

TEMPLE RESIDENCE: □ YES □ NO. If Yes, Name of Temple:

Profession:

When and where did you pass your ISKCON Disciple Course and Initiation Exams?

I hereby declare that this form represents a true and accurate statement about myself.

Date: Place: Signature: