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CLASS ENROLMENT - SUNDAY RE(TREAT)
PRIVATE & CONFIDENTIAL
Personal information collected assists Reconnect Yoga in providing a class catered to your needs. Information provided will only be used for teaching purposes only unless further consent has been provided by the person below for other use. Information collected will be stored securely. Access will be in accordance to the Victorian Privacy Act. If you have any concerns regarding this form, please contact Wai Ying on 0412023688 or
reconnectyoga@bigpond.com
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First name
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Your answer
Last name
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Your answer
Postal Address
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Your answer
Contact Number
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Your answer
Email
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Your answer
Please book me into the Sunday Re(Treat)
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Spot will be confirmed on receipt of payment.
10th Nov Sunday 2 - 5pm - $50 Donation
Required
Reserve your spot through payment. Please choose the option that you will be using. Please contact us if you need to discuss a payment plan.
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Direct Credit Details:- A/c Name: Reconnect Studios BSB 063111 A/C Number 10779447
Direct Credit. Banking details above. Please reference with your name
Cash. Only available to existing weekly students at Reconnect Yoga
Chq. Only by prior arrangement
Need to discuss. Please ring.
How did you hear about this event?
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Referral from friend
WOMO website
Poster
Brunswick Secondary College
Other:
Is this your first class enrolment at Reconnect Yoga?
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Yes
No
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