The Wellness Collective Secunda Registration Form
Workout and nutritious Breakfast event
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
WhatsApp number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
How did you hear about us?
*
Please Select
Word of mouth
Fitdoll Instagram page
Wellness Organics social media pages
Other
Please Specify
Wellness Collective Ticket
Please Select
x1 Ticket R650
x2 Ticket R1300
Bank Name: Capitec Business Account Name: Wellness Organics Account Number: 1051980461 Branch Code: 450105 Select Capitec Business. Reference: Name and Surname
Upload Proof of payment
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Terms and conditions
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Wellness Collective Ticket
General ticket for 1 person R650. Includes 1x goody bag, 45min workout and nutritious Breakfast
650.00
ZAR
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Dietary requirement
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Vegan
Vegetarian
Nut-free
Should be Empty: