Central Coast | Body Mechanics

APPLICATION FORM

To participate in one of our classes, print out and complete this form and send it with full payment or deposit to:

CC Body Mechanics, 37 Althorp St, East Gosford NSW 2250

 

Name: ……………………………………………………………………………………………..

Address:…………………………………………………………………………………………..

……………………………………………………………………………………………………….

Phone:…………………………………..email:………………………………………………..

Occupation:………………………………………………………………Age:………………..

Class you’d like to attend: Time:……………………Day:………………………………..

What would you like to get out of these classes?………………………………………

……………………………………………………………………………………………………….

I am sending $20 to secure my place [ ]

(Full payment to be made at the first class)

or

I am sending full payment of $130  [ ]

 

(Please make cheques payable to Tim Barrett)

 

I agree to take full responsibility for myself  during classes

 

 

Signed:……………………………………………………………..

 

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