Registration Form


Fill up the Registration Form and send it at the following address. In return, you will be offered:

1.        One year of uninterrupted fully confidential counselling related to personal, educational, career, life, business, and entrepreneurial situations.

2.        Author's Edition of Bestselling Books by Dr. Ajay Rai at special rates.

3.        Right of participation to all activities initiated and conducted by Dr. Ajay Rai at special rates.

4.        Based on your growth and development, at the end of one year, the "Ultima Award" by Dr. Ajay Rai.

This is an amazing package that guarantees you all round

Effective Achievement


Date Of Birth________________________


Address, including phone number(s) and email id


























































































































































What Is Your Immediate Counselling Requirement






I Promise To Abide By Instructions Given By The Consultant From Time To Time. I Promise Also To Behave With Dignity. I Understand That All Services Rendered By The Consultant Will Be The Best Possible Under The Given Circumstances And I Will Not Hold The Consultant Responsible For My Action. I Understand That Annual Registration Will Entitle Me To A Maximum Of 7 Interactions. All Assistance That I Get From The Consultant Will Be For My Own, Personal Use And For Nothing Else.


Date: ______________________________                                 



Dr. Ajay Rai, 153/18 Shipra Path, Mansarovar, Jaipur 302020, India

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