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Name:
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Registration is Essential
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Address:
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Money is not refundable however classes are transferable to other classes within the term.
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Payment required to book placement
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Phone:
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o Cash payment $ ………..
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Email:
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o Please charge $……….. to my credit card
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Health Fund:
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o Bankcard o Mastercard o Visa
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Class Type:
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Expiry date ……../……….
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Day: Time:
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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Term 4 P/B, P/M & T/T each $99
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Name on card ………………………………………
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o Tick this box if this will be your 1st Pilates class
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o I have my own correct sized certified anti-burst ball
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Signed ……………………………………………
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o Please contact me
re. ball purchase
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Please post, phone/email details or deliver in person to: Wellness Centre, Phone: 02 4267 4448 Fax 02 4267 1706
185 Lawrence Hargrave Drive Thirroul 2515
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