To participate in one of our classes, printout and send the completed form and payment to:

CCBodyMechanics
37 Althorp St, East Gosford. 2250
______________________________________________________________________


Name of Participant:_________________________________________


Address:__________________________________________________

_________________________________________________________


Phone:___________________ Email:__________________________


Occupation:________________________________________________


Age:_____________________ Sex:__________________________

Which Class you are interested in:Class____________________

 

                                                            Day:____________________

 

What would you like to get out of these classes?



I am sending $20 to secure my place ____

(Full payment to be made at the first class.)


I am sending full payment of $130 ______
(Please make any cheques payable to Tim Barrett)

I agree to take full responsibility for myself during the classes


Signed: __________________________________________