Meditation Practice - Online
Enrollment Form

Name:

Email:

Home Phone:

Work Phone:

Mobile:

Address:

Post code:

Start Date:

Method of Payment:

Cheque Bank Transfer

Amount: $250.00

Preferred method of payment is electronic funds transfer, which should not incur a bank fee. Please check with your bank to be sure.

Bank details are:

Michele Sierra
St George Bank
BSB: 112 879
Account: 027939819

If paying by cheque, please make these payable to Michele Sierra and post with a copy of your enrolment form to:

Michele Sierra
12/35 Old Northern Rd,
Baulkham Hills NSW 2153

To pay by credit card, please submit enrolment form and you will be contacted directly to assure the secure recording of your card details. Alternatively please contact 0419 018 433 at your convenience. Note that credit card payments incur a two per cent surcharge

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