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X Women Boot Camp Registration
You are registering for the 10 week ladies body transformation programme
Email address *
Full Name: *
Your answer
Address: *
Your answer
Mobile Phone Number *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Doctors Name: *
Your answer
Doctors Contact Number: *
Your answer
Medical Background
Do you suffer from any of the following: *
Required
Please explain any of the above:
Your answer
Are you planning to become pregnant?
Do you take any supplementation or medication? (please list and explain)
Your answer
Nutrition
Do you suffer from any of the following:
Please explain any of the above:
Your answer
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
Required
Extras:
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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