Feel Energised Membership

Feel Energised Membership/Programs

Registration Form
Please let us know where you stand so we know what to do next *

I am happy to get startedI have a few more questions and would like to talk with somebody first.
How did you hear about our membership/programs*
If someone referred you, please let us know who that was so we can thank them
Full Name*

First NameLast Name
Email*
Program/Membership/Personal Training Options (tick if interested - payment not processed via this form)

Online Reconnect Your Core Program $149Online POST NATAL Reconnect Your Core Program $1498 week Small Group Mums & Bubs Sessions (Nelson Based Mums) $149One on One Personal Training Session from $30Feel Energised Monthly or Annual Membership
Client confidentiality
We do not share your information with any other individuals, companies or websites. All information included in your questionnaire is held strictly confidential.

Informed consent
I hereby acknowledge that the information provided above regarding my health is, to the best of my knowledge, correct. I will inform you immediately if there are any changes to my health status.

Disclaimer
I acknowledge that participation in physical activity carries a risk and I accept all responsibility for that risk.
Signed (Full Name)
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Feel Energised Membership/Programs