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Fusion Community Center of NJ

650 Pascack Rd, PARAMUS, New Jersey 07652, USA

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Yoga Class for Women (Individual class registration)

26
JAN

04
JUL

Program Fee:

One Time: $15.00

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Reserved Seats: 43/50

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

Choose Program

+ Add More Registrants

3 Payment

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Fusion Community Center of NJ consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Since you purchased free Ticket No Payment Required.

Comments

Payment Summary

Program Fee

Total Registrants

Total Cost

Acknowledgement

By registering, you acknowledge that participation in any physical activity may result in injury and that you assume all risks of participation in this activity. You further acknowledge that you will not hold Fusion, its teachers and/or its volunteers liable for any injury or loss incurred as a result of your participation in this activity.

Fusion Community Center of NJ

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Yoga Class for Women (Individual class registration)

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

Acknowledgement

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