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Register for the 16 Week Program
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Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Australia
Country
Phone
*
Email
*
I would like to enrol in the 16 week Stress and Anxiety Program which begins on:
Select applicable
*
Wednesday 12th February 2025 6.30pm - 8.30pm
I have read the Outline of the Program on the website as well as the Client Information sheet and agree to pay $50.00 (waged), $35.00 (pensioner/students) per week.
*
Agree
