Face Yoga and Joyful Movement
Name
*
First Name
Last Name
E-mail
*
example@example.com
Mobile Number
*
Tai chi class (e.g Rangiora)
Nutritional needs/ allergies
Payment made (e.g. $80 deposit)
Pay cash or into bank account 12 3236 0066683 000 Please reference with your name and workshop
Balance to be paid at the workshop or through online banking
Pay to bank account 12 3236 0066683 000
OR Payment by credit card
prev
next
( X )
Deposit
$
80.00
NZD
Quantity
1
2
3
4
5
6
7
8
9
10
Full Payment before 12th September
$
160.00
NZD
Full payment after 12th September
$
180.00
NZD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit Application
Should be Empty: