Pilates Registration

Name:______________________________________________                 

Address:____________________________________________             

City:_______________________________________________                   

Tel:______________   

Session Registered For:_______________/___________________
                                        (Day)                    (Level)

Referred by: ___________________________________                       

Payment to: Pacific Interior Pilates                  
                  #102 - 546 Leon Avenue
                  Kelowna B.C.
                  V1Y 6J6,          

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Cheque #_____________________Received:_____________