RC-Annie Ltd - Registration Form

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REGISTRATION FORM

FULL NAME
ADDRESS
PHONE
MOBILE
EMAIL
WEBSITE
SPOTLIGHT VIEW PIN
DATE OF BIRTH	dd/mm/yyyy
MEDICAL HISTORY
DO YOU EXERCISE?		WHAT DO YOU DO?
CURRENT MEDICAL CONDITIONS?		DO YOU TAKE MEDICATION?
ANY ALLERGIES?		RECENT INJURIES?
YOUR HEIGHT		YOUR WEIGHT
COURSE INFO
COURSE DATE	dd/mm/yyy
COURSE NAME
FEE
CONCESSION TYPE	Performer in Rc-Annie shows Members of: Equity BADC Swashbuckler Shooting people Talent Circle Actor/Singer/Dancer Mandy.com EHCG Students and unemployed Early Bird
PREVIOUS STAGE COMBAT EXPERIENCE		QUALIFICATIONS
HOW DID YOU HEAR ABOUT RC-ANNIE
PAYMENT METHODS
How would you like to pay?
CHEQUE	PayPal Please add £5.00 to your fee if you select PayPal
RECIEPT		Classes undertaken at participants own risk Please select "I Agree" to confirm.
DATE	dd/mm/yyy
Please note we do not offer refunds; we will defer in certain circumstances.

Please remember to state whether you are paying by:

Cheque: make cheques payable to Rc-Annie Limited and send to:

34 Pullman Place.
Eltham.
London.
SE9 6EG.

PayPal: we will send you a PayPal payment request via your email address.