I wish to register for the Beginners Course commencing:……...............………....Time:…............................
Name: …………………………...........……....Address............................................................................... ..................................................................................................................... Phone:…...............…...... .Email:………...................……........
How did you learn about Yoga Om?
Friend.................... Flyers................. Advertisement......................... Others...........................................
What is the best way to contact you?
Post / E-Mail / Sms / Phone ( H - W - M)
Please specify if you have any medical condition, injury and/or back/neck problems:
……………………………………………………........................................................…………………….........
……………………………………………………......................................................………....………..............
Participants should practice on an empty stomach.
The information on this sheet will remain confidential & help us to design your programme better.
Please enclose payment of BC 85, BI110$, (non-refundable, non-transferable).
Cheques or Money Orders to be made out to Regi Clarence. ABN 350 5463 8073
Postal Address: 15 Quelea Place, Ballajura – 6066.
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