Bookings & Registrations Step 1 of 250%Event Category IDReferring URLEvent price tagEvent quantity tagPersonal InformationPlease provide your personal details here.Your Name* Name Surname Phone*Your email* Website (optional) Date of Birth*Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Gender*Please select ..MALEFEMALEYour addressStreet addressCity*StatePlease select ..VictoriaQueenslandNew South WalesNorthern TerritoryWestern AustraliaSouth AustraliaTasmaniaZIP / Postal CodeCountryAustraliaOther ..Other coutryYour interest*Choose your interest ..300hr Yoga Teacher Training200hr Yoga Teacher TrainingRetreatsWorkshopsPlease, choose your interest.Yoga / Pilates ExperiencePlease describe your Yoga / Pilates experience*Yoga HistoryPlease answer the following questions briefly.Where did you receive your 200hr Certification?*Please choose ..Pilates & Yoga Styles, Geelong VICOther ..Which Yoga School did you graduate (200 Hr) and graduation dateDo you currently teach yoga?*YESNODo you have any physical limitations we should know about?*NOYESPlease specify*Is there anything else you'd like to add?*NOYESPlease provide it in a message ..*Additional InformationHow did you hear about the course?* Our Website Google Search Results Social Media Online Advertising Friends Referral At our StudioPlease select any one or more available channels.Confirmation* I have read, understand and agree to the terms and conditions and undertakings applying to the program to be provided to me by Pilates & Yoga Styles, Geelong West VIC. Confirmation detailsDeposit: To secure your place we require a AUD$500.00 deposit per person (non refundable) that is payable now.Full Payment: The due date for full payment of booking is 6 weeks prior. However we can still accept bookings after this date, subject to availability.Event titleShort descriptionOriginal event URL Event start dateEvent end datePayment detailsProduct Name* Price: $ 0.00 Quantity*Please enter a number from 1 to 3.Total $ 0.00 Credit Card Details*American ExpressDiscoverMasterCardVisa Card Number Exp Month010203040506070809101112 Exp Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Exp Date Security Code Cardholder Name Secure payments provided by Stripe secure payments processing. Security is one of the biggest considerations in everything we do. The Customer hereby and on the 02/21/2020 applies to register an account with Pilates & Yoga Styles, Geelong VIC in respect of the services, training and product supply.The Customer hereby acknowledges receipt of and accepts Pilates & Yoga Styles General Terms & Conditions of Sale.Confirm you're a Human!EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.