Business Information

Straya Fitness Pty Ltd

dropbearbjj@gmail.com

New Location

5 Faith Av., Plainland, QLD, 4341, Australia

ABN

95652527676

Credit Card Details

All fields are required unless marked as optional.

First name

Last name

Address

Address 2

City

State

Phone Number

Postal Code

Card number (no dashes or spaces)

Security Code

Exp. Month

Exp. Year

Name (as it appears on your credit card)

Parent or Legal Guardian

Enter the name and contact details of the individual who holds legal responsibility for the applicant.(if under 18 yrs)

Emergency Contact

Please provide the name and contact details of a person we can reach in case of an emergency

Students Details

Represents the student participating in the program.

	First name	Last name	Date of birth

Signature of Member or Legal Guardian

Space for the signature of the member or their legal guardian, confirming consent or agreement.

Please Note

By completing the form below, you agree that Straya Fitness Pty Ltd will securely store your payment details on file and will charge you automatically when a payment is due. You also acknowledge that you have read the Terms and Conditions by clicking here.

I agree to the Terms and Conditions