Registration for Additional Modules

Complete this form to register for course modules additional to your original study stream.

* indicates required field

First Name:*

Last Name:*

Email:*

Your Mobile Phone:*

Your Work Phone:

REGISTRATION FOR ADDITIONAL MODULE(S):*

Beginner Mat ($500)
Intermediate Mat ($500)
Beginner Reformer ($700)
Intermediate Reformer ($700)
Beginner Studio ($800)
Intermediate Studio ($800)
Rehab Applications 1 ($900)
Rehab Applications 2 ($900)

ENTER PAYMENT TOTAL:*

SELECT PAYMENT METHOD: - Payment must be received to confirm registration:*

Bank Transfer - BSB 013200, Acct #: 375883153, Acct name: Balance and Control Pilates
Cheque - Made payable to "Balance & Control Pilates" and posted to Suite 3, 474 Victoria St, RICHMOND, VIC, 3121

Additional comments to accompany your registration:

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Thank you for your registration
Your registration will be confirmed upon receipt of payment