Nourish Retreats Booking Form

Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Address
Street Address Suburb Post Code
Home Phone*
Mobile*
Email*
Any relevant medical conditions or food allergies:
Date of retreat
Date Format: MM slash DD slash YYYY
Where did you hear about this retreat?
Payment Method*
Initial Deposit
I, __________________________, enclose $200 deposit (non-refundable and only transferable once) for the above mentioned course. I understand that remaining payment must be paid in full 2 weeks prior to commencement of course. I understand that if I cannot attend this retreat for any reason that I must notify Nourish Body & Beauty as soon as possible.
Full Payment
I, __________________________, enclose $__________, being the full/final payment for the above mentioned course.
Direct Deposit
Payable to Tina Rossiter BSB: 014669 Account No. 390190662 Please use surname as a reference. Email receipt to nourishbodyandbeauty@gmail.com or via text on 0438 505 544.
Payment by Credit Card
Payment by credit card can be made by phoning Nourish Body & Beauty on (07) 5441 2408 or 0438 505 544.

Initial Deposit