Dancing for Birth Classes Booking Form

1. Page 1

 

1. Name

 

2. Address

 

3. Phone Number

 

4. Mobile Number

 

5. email Address

 

6. When is your due date?

 

7. What date do you want to start Dancing for Birth classes?

 

8.
Please send payment via BACS to 

sort code 40 47 42
Account 51476890
Account name R Dhoopun

Cost is £10 for a one of session
£45 for 5 sessions
£85 for 10 sessions

Once your payment is received your place is confirmed and receipt will be emailed to you.

Many thanks

Check out our survey templates or create your own.
Report Abuse