Pilates Registration Form

Participant Registration Form
Name:*

First NameLast Name
Preferred class day

MondayWednesdayFriday
E-mail*
Phone Number*
How did you hear about us?*

Facebook/Social MediaWord of MouthWebsiteGoogle/Search Engine
Do you have any current or past injuries or conditions that may impact of be impacted by your participation in exercise?*
What would you like to achieve by doing pilates?*
In Case of Emergency
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to you*
Payment Method
Add a payment method here from the Payment Tools on the left side.

My Products*

1x Weekly Pilates Class($10.00AUD for each week)

2x Weekly Pilates Classes($20.00AUD for each week)

3x Weekly Pilates Classes($25.00AUD for each week)

Which Class/es would you like to book for? (choose based on number of classes selected above)*

MondayWednesdayFriday
Your registration is subject to the following terms found here: https://ulinaphotography.com/pilatestcs (subject to change.)
I have read, understand and agree to the aforementioned terms and conditions*

Yes
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Date of Birth*

MonthDayYear
Date
Should be Empty:

Participant Registration Form