Registration for firewalking workshops or fitness bootcamps

Registration form

To register for one of our firewalking one-evening workshops or fitness boot camps, please fill-in the online form below and we will contact you to obtain your payment details. Please provide the following contact information and we will be in touch with you to confirm your reservation. Note that items marked with an asterisk * are required in order for this form to be processed correctly.

Before proceeding, please read our terms and conditions.

Name: *
Title:
Organisation:
Street address: *
City: *
State: *
Postal Code: *
Country: *
Work phone:
Home phone: *
Mobile phone:
Fax:
Email address: *
No. of persons: *
Preferred date: *
Additional info:
Please type in the above authentication code in the space provided below.
Please type in YES below to indicate that you have read and accepted our Terms and Conditions.
	I / We accept.