2023 - 21 Day Kickstarter - REFERRIZER

Studio*

Membership Options *

21 Day Kickstarter - Unlimited Training $89.99

for new members only

Name*

First Name

Last Name

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Membership Terms and Conditions

I have read, understood and agree to the Terms & Conditons

*

I understand that after the initial period listed above, I will automatically roll over into an Unlimited Flexi Membership. If I do not wish for this to continue, I must email the studio at least 48 hours before the conclusion of the 21 Day membership.

Please Select a Payment Method*

Credit Card Direct Debit

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Card Number*

Card Expiry*

MM/YY

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By signing this form, I/we authorise Ezidebit, acting on behalf of the Business, to debit payments from my specified Credit Card above, and I/we acknowledge that Ezidebit will appear as the merchant on my credit card statement.

I/We authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID No 165969, 303909, 301203, 234040, 234072, 428198) to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with the Debit Arrangement stated above and this Direct Debit Request and as per the Ezidebit DDR Service Agreement (Ver 1.9) provided.

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Date*

Notes