APPLICATION FORM

Massage Courses available 
   
Course A) Beginners Relaxation Massage
Course B) Elphinstone Technique Massage

Name: Ms / Mrs / Mr / Miss ____________________________________

Qualifications:______________________________________________

Address: __________________________________________________
      ______________________________________Postcode:_________

Phone: _________________________ Fax: ______________________

Email:_____________________________________________________

Massage Course (A)               Massage Course (B)     
(please indicate which course you wish to attend)

Deposit Paid: $_______                Balance Due $                  

Signature: _______________________  Date: ____________________

Registration:

Please send the application form with the deposit payment of $99 payable to
Gloria Elphinstone (ABN: 56 551 069 920)

Balance of (A) $300 or (B) $400 is to be paid on or before the first day of the course.

Payment may be in:

Cash, Bank Cheque,

Money Order

Direct Deposit payable to 
Account Name:  Gloria Elphinstone,
Bank :              Commonwealth Bank
BSB Number:    067 028            A/c Number:  10053792
Please send a copy of evidence of the deposit for payment with your application form.

Phone Gloria on 0403 131 746 for postal details.

Time payments can be arranged with Gloria please phone for a confidential arrangement.