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X Women Boot Camp Registration
You are registering for the 10 week ladies body transformation programme
Email address *
Full Name: *
Address: *
Mobile Phone Number *
Date of Birth: *
Doctors Name: *
Doctors Contact Number: *
Medical Background
Do you suffer from any of the following: *
Please explain any of the above:
Are you planning to become pregnant?
Clear selection
Do you take any supplementation or medication? (please list and explain)
Do you suffer from any of the following:
Please explain any of the above:
The days and times I am booking in for? *
You are able to do two sessions per week. If for some reason you are unable to make one of the two following days you can choose one of the other sessions to make up that class. E.g. 9am Monday and 5.30pm Thursday
I heard about this programme through? *
I acknowledge that the information I have provided is correct and if anything changes I will inform my instructor. *
I will be paying the $400 programme fee by: *
We ask that your payment is made prior to your start date. The options to pay are below. If you have any other questions please ask.
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