Please select a payment option and complete the billing agreement below - no credit card required. Unless you are renewing or amending an existing agreement - once this form is submitted you will be then be sent a debit schedule to confirm and complete.

LEFTFIELD TRAINING BILLING AGREEMENT

Name

First Name

Last Name

Email Address

Date

YYYY

Please select from the following billing options

All payments are debited fortnightly in advance. You will be sent a payment schedule including a pro-rata adjustment as necessary for confirmation.

If your health status changes at any time (i.e. injury or medical condition) you must notify your trainer so appropriate modifications can be made to your training program. Injury or illness does not release you from your obligations under this agreement. Payments are not refundable.

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Transaction fees may apply to some credit cards as per the Ezidebit schedule.

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Leftfield Training will provide 30 days notice to the client regarding any changes in rates

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Sessions are 50 minutes in length and start at the scheduled time. Sessions will not be extended due to the tardiness of the Client or due to interruptions made by the Client. Any Client who has not arrived within 15 minutes after the scheduled time shall be deemed cancelled and will be charged for that session.

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Missed sessions or sessions cancelled with less than 24 hours notice are forfeited by the client, and will not be refunded or rescheduled. Sessions can be rescheduled at the discretion of Leftfield Training. This is a reflection of the nature of this service whereby vacancies cannot be filled at short notice. This policy is enforced 100 percent of the time, and should not be taken personally.

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Leftfield Training retains the right to terminate this agreement for any reason including but without limitation to, clients failure to follow direction or conduct such as to adversely effect participation of other paying clients or contrary to the interests of this agreement.

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You acknowledge this program has a minimum commitment of 12 weeks after which, with 14 days notice you can cancel your participation at any time. Payments are not refundable *

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I authorise Leftfield Training to process on my account due date all charges I have incurred for the previous month, if any, as well as all fees due in advance. I have read and understood, and agree to all terms and conditions.

YES

A copy of this form will be emailed to you for your records