Laughter Yoga Leadership Training- Registration Form

E-mail Address: *

First Name *

Last Name *

Address *

Suburb *

State *

Postcode *

Country *

Date of Birth (dd/mm/yyyy) *

Gender *

Best contact number (preferably mobile). If land line please include area code. *

Alternative contact number

Occupation

Company

Payment Method *

Cash via Bank Transfer
Credit Card via Paypal

Please book me in for *

Monday 15 & Tuesday 16 April 2013
Saturday 27 & Sunday 28 April 2013

How did you find out about us? *

If OTHER please describe

I understand that cancellations within 14 days of Vibrance events incur a $50 fee and that cancellations within 3 days are non-refundable. *

Vibrance Whole Health & Fitness