Fitness Booking >> Health and Lifestyle Questionaire >> Payment

First Name : *   Last Name: * Phone: *   E-mail: * Mobile: *   Occupation: Address:* Suburb:*   State:* NSW ACT QLD VIC TAS WA SA NT Other Post Code:*   Country: Please sign me up for: Spring Challenge - 1 x session per week for 3 weeks $60.00 Spring Challenge - 2 x sessions per week for 3 weeks $110.00 Spring Challenge - 3 x sessions per week for 3 weeks $160.00 Term 4 - "Beach Camp for Goddesses" 1 x Session per week/8 week term $120.00 Term 4 - "Beach Camp for Goddesses" 2 x Sessions per week/8 week term $220.00 Term 4 - "Beach Camp for Goddesses" Casual Session $20.00 Term 4 - "SurfFIT for Goddesses" 1 x session per week/8 week term $220.00 Term 4 - "KayakFIT for Goddesses" 1 x session per week/8 week term $220.00 Please type the session day and time that you wish to attend:   Date:   Time: How did you find out about Urban Goddess?   Would you like to receive Urban Goddess Online, our monthly e-mail publication and occasional information about special events and programs?   yes No