REGISTRATION FORM

Select your class:

	Cycle Excel Indoor Cycling Certification – Level 1 $225.00
	Cycle Excel Indoor Cycling Certification – Level 1 and level 2 $325.00
	Cycle Excel Advanced – Level 2 is only available for instructors who have completed Cycle Excel level 1 $125.00
	Cycle Excel Motivation and Visualization / Power interval Training $99.00 each

 

Participant Details:

Name:
Address:
Post Code:
Phone:
Email:

Payment Methods:

 

 

Exp:
Cardholders Name:
Cardholders Signature:

 

Cheques made payable to:

Donna Ellerton, P.O. Box 1370 Saint Kilda, South Vic 3182

Direct Funds Transfer:

Account Name: Donna Ellerton, Commonwealth Bank BSB: 06 3161

Account Number: 100 34333 - Reference: cycle, date & your “surname”

 

 

Disclaimer:

I herby willingly and freely consent to participation in the above workshop(s) at my own risk. I am in reasonable physical health and acknowledge the inherent risk involved in my participation in this activity. I herby accept all such risks involved and expressly waive any and all rights that may arise in relation to my participation.

I acknowledge that I have read the above statement:

Signature of participant:

 

Please print and send completed form and payment to:

 

Donna Ellerton

P.O. Box 1370 Saint Kilda, South Vic 3182

Mobile: 0405 514 462 – International: +61405 514 462

Email: info@donnaellerton.com

info@cycleexcel.com cycleexcel@gmail.com