This form is to enroll onto the following course: Reformer Pilates Instructor Course To begin, please read and accept: AFA's Terms & Conditions of Enrolment.Please tick this box to acknowledge that you have read AFA's Terms & Conditions* Tick Here Have you completed any of the following qualifications?* Certificate III in Fitness Certificate III & IV in Fitness Mat Pilates Certificate Reformer Pilates Certificate None of the above Do you have previous experience participating in Pilates?* No Prior Experience 0-25 Hours Participation 25+ Hours Participation Do you hold current membership/registration with any of the following organisations?* FITREC AUSactive Physical Activity Australia Pilates Association Australia None of the above Personal Details:Title*MsMissMrsMrOtherFirst Name*Last Name*Email* Alternative EmailPhone*MobileGender*FemaleMaleNot StatedOtherDate of Birth* DD slash MM slash YYYY Street Address*City*Post Code*StateVICNSWQLDSAWATASACTNTShipping Address Same as billing address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Select Your Study Option* Online Face-to-Face Do you have an Online Coupon Code?If you are an AFA Student/Graduate, feel free to call us on 1300 232 348 to request a $100 coupon code! Yes Coupon Code*Do you have a F2F Coupon Code?If you are an AFA Student/Graduate, feel free to call us on 1300 232 348 to request a $100 coupon code! Yes Coupon Code*Online Payment Options* Reformer Pilates Course Online - Upfront = $2,450 Reformer Pilates Course Online - Direct Debit = $100 Deposit ($2,350 Remaining) Online Payment Option (Discounted)* Reformer Pilates Course Online - Upfront = $2,350 Reformer Pilates Course Online - Direct Debit = $100 Deposit ($2,250 Remaining) F2F Payment Option* Reformer Pilates Course F2F- Upfront = $3,450 Reformer Pilates Course F2F- Direct Debit = $100 Deposit ($3,350 Remaining) F2F Payment Option (Discounted)* Reformer Pilates Course F2F- Upfront = $3,350 Reformer Pilates Course F2F- Direct Debit = $100 Deposit ($3,250 Remaining) Select Your Intake:* January - 30/01 to 14/02 Future Date - TBC Total $ 0.00 You'll be able to make payment via our secure checkout on the next page.
