EmailMe Form - LADIES - Get the BEST Model body in 12 weeks!

Your Full Name *

Date of Birth

DD / MM / YYYY

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number *

Email *

Do you have any medical conditions, or are there any reasons why you should not engage in diet and exercise due to health or physical reasons?
Use this space to tell us prior to submitting.

Please email me with other offers, info and events *

Yes

No

I understand that by using this form, I am committing to a 12 week program at South Yarra Fitness.
I understand cancellations require no less than 24hrs notice by telephoning Melody on 0433 393 333 or by email sthyarrafitness@gmail.com
Late cancellations will be counted as a session.

I understand results may vary between individuals and success is dependent on my commitment and dedication.
I have accurately declared all injuries, movement limitations, and medical conditions and am in a fit state to exercise.
I am fit to follow a healthy eating plan.
I understand that a further assessment will be required prior to commencement.

This offer is limited to 1 per person, and can not A deposit of $100 or full payment must be made on submission of this form to qualify.
20 places only.
Sessions will be at South Yarra Fitness at 337 Toorak Rd, South Yarra, Vic 3141 *

Yes, I agree.

On submission of this form you will be redirected to a payment options page.

You can choose to direct debit either weekly, or every 4 weeks. Payments will commence within 7 days of debit form being submitted.

Further detail on booking will be available.
Please telephone Melody on 0433 393 333 if you have any problems using this form, or if you have any question or concerns prior to submitting.
Thank-you, and SEE YOU SOON!

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