GYROTONIC® method Certification Course Registration Name* . . Address* . Email* Mobile Phone*Studio AffiliationStudio Website Studio Address . Studio PhoneSELECT THE SPECIFIC COURSES YOU ARE REGISTERING FOR:GYROTONIC® method certification course* GYROTONIC® method certification course April 24-26, 2020 Studio fee of $350.00 AUD to reserve your spot must be received. There are only 12 spots available so register ASAP to avoid missing out. Course fee of $350.00 USD to be paid directly to Specialized Master Trainer Rita Renha on the first day of the course. ENTER PAYMENT AMOUNT BASED ON YOUR SELECTION ABOVE:*SELECT PAYMENT METHOD : (Payment must be received to confirm registration)*CHEQUE: Made payable to Energy Kinetics® Instructor Training, Studio A 2 Percy St, Prahran, VIC, 3181BANK TRANSFER - Enter Transaction number below:ANZ Middle Brighton Branch, 54 Church St, Brighton, VIC, 3186. Account Name: Energy Kinetics® Instructor TrainingSwift code: ANZBAU3MBSB: 013355Account No.: 497427519Bank Transfer Transaction Number/Cheque Number:All Deposits are non-refundable and non-transferableTerms and Agreements*I understand that I alone am responsible for any accidents that occur or injuries that may be sustained in any work I may do as a part of my training at Energy Kinetics® and that neither Energy Kinetics® nor any of its employees will be held liable for any such injuries or accidents. Check this box to acknowledge you have read and completely understand the statement above and its contents. CAPTCHAComplete the security ‘CAPTCHA’ field above before clicking SUBMIT.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.