EmailMeForm
KEC Rally Booking
Instructor Name
*
Date (1)
*
DD
/
MM
/
YYYY
Date (2) if 2 day clinic
DD
/
MM
/
YYYY
Name
*
First
Last
Assessed Level
Preferred Time (we will try to accommodate if possible)
Current Facility Member/Agistee
Please select
Yes
No
Payment
*
On-line
Cheque (bank deposit)
Amount ($)
*
Receipt No.
*
BOOKINGS ARE NOT ACCEPTED WITHOUT BANK RECEIPT NO.
Email
*
Your best contact no.
Notes