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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
*
Tuesday, 11th February 2020 7pm - 9pm
(evening group)
I have read the Outline of the Program on the website as well as the Client Information sheet and agree to pay $45.00 (waged), $35.00 (unwaged/student) per week.
*
Agree
