Online Registration form

Name

First Name

Last Name

Address

Email Address

Phone

(###)

###

####

I am a

Membership number

Morning Session: 10:00-12:00

Guigen Qigong (Coralie Crocker)

Martial Arts Application B24 part 2 (Konrad Dorn)

Afternoon Session: 13:30-15:30

Yin Water Form (Su Rule)

Push Hands (Norman Chong)

Cost

Full Day: WTQA Member: $60 Non Member: $80 One Session: WTQA Member: $35 Non Member: $50

Payment

If paying by EFT or Bank Transfer: Bank: Westpac Banking Corporation Branch: Ashburton BSB: 033106 Account Number: 315036 Account Name: WTQA Please note: Use your initial and surname as reference and include the receipt number in the field below If paying by money order or cheque, please make payable to: Wushu Tai Chi and Qigong Australia INC Registration, release forms and payment to be mailed to: Wushu Tai Chi and Qigong Australia INC. PO Box 246, Ashburton, VIC 3147

Initial, surname and receipt number (for EFT or Bank Transfer)

I have read and agree to the terms and conditions

Yes

Terms and conditions

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