Name *

First Name

Last Name

Phone *

(###)

###

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Type *

One-Time Class

Recurring Class (weekly)

Recurring Class (bi-weekly)

Recurring Class (monthly)

Theme *

Basic Mat Pilates

Restorative Pilates

Pilates for Lower Back Pain

Barre-Style Pilates

Pilates for Better Sex

Intuitive Movement

Breathwork Breakthrough

Group Reiki Healing

Date

MM

DD

YYYY

Time

Hour

Minute

Second

AM PM

Payment Preference *

One person will pay for the whole group (specify below)

Each participant will pay individually

Billing Contact

(if one person will pay for the whole group, please specify their name, email address, and phone number)

First Name

Last Name

Billing Phone

(###)

###

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