Are you currently exercising:
Tell me about any health issues or injuries you have. (please select any that may apply:
IMPORTANT NOTICE: It is wise to seek your doctor’s advice before beginning any health/fitness/nutrition program!
With doctors and physician support, are you able to participate in an exercise program? 
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Add any further comments or questions below.
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REGISTRATION FORM -  please select one
Choose your preferred session times    (min. 2 Sessions):
*This Discounted Offer only applies to new members taking up the above Program
Choose your preferred payment plan. 


PAYMENT METHOD
Option 1
Option 2
Weekly Direct Debit
Payment in FULL  - for the weeks of the Term
Health & Fitness Questionnaire
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Age:
Your Name:
Your Phone No:
Your email:
ADD... a membership for Not a Gym Classes
Direct Debit will incur a $2 transaction fee.
Your Address:
Bank Details / Payments to be finalized on our Registration day to be advised
DATES for 2019
Term 1a - 6 week BLITZ       Term 1b - 7 week BLITZ
14/1 - 23/2                                         4/3 - 20/4

Term 2 - 12 week CHALLENGE  29/4 - 20/7

Term 3 - 10 week CHALLENGE  29/7 - 4/10

Term 4 - 10 week CHALLENGE 7/10 - 13/12

Not at allA couple times p/wk2-3 times p/wk3+ times p/wkMost days
High Cholesterol
High Blood Pressure
Heart or Lung Conditions
Hernia
Arthritis
Asthma or respitory proplems
Seizure Disorder
Diabetes
Back Pain
Neck Pain
Joint Issues or limitations
Recent Broken Bones
Recent Surgery
Recent Injuries
Muscular Disorders
Other:
YES. Click to agree... & type your name:
Pregnant or given birth recently
Any infectious Diseases
Take prescribed medication
Heart or Lung Condition
SAT 7am
TUE 5.45am
THU 5.45am
TUE 7.30pm
THU 7.30pm
x3 Sessions a week @ $12 ea = $36pwk
x2 Sessions a week @ $14ea = $28pwk
x3 Sessions a week ($36pwk) x the Term weeks
x2 Sessions a week ($28pwk) x the Term weeks
$180*12wk Not a Gym Membership
TERM 2 - 12wk CHALLENGE 29/4
TERM 3 - 10wk CHALLENGE 29/7
TERM 4 - 10wk CHALLENGE 7/10