Class Application Form

APPLICATION FORM

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 $120 ______
(Please make any cheques payable to Tim Barrett)

I agree to take full responsibility for myself during the classes

Signed: __________________________________________