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Please complete one form per participant, using unique email addresses for each participant.

 

Contact Details

Please fill in your contact details.

Choose your area and session time:*
What date do you want to start training?*
Please select your offer / promotion:*
I aiming to attend:*
Have you trained with evolution before?*
Do you agree to the rules of the game?*

Ezi Debit Terms and Conditions

Evolution to Wellbeing does not store any bank or credit card details.

This is a secure area of the site which uses Secure Socket Layer (SSL) to protect data submitted.

If you select Direct Debit - EFT as your method of payment please enter your BSB and Account Number. If you select Credit Card or skip these and enter your credit card details.

For Direct Debit: I/We authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID No 165969) ("Ezidebit") to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with the Debit Arrangement stated above and this Direct Debit Request and as per the Ezidebit DDR Service Agreement provided.

For Credit Card: I/we authorise Ezidebit, acting on behalf of the Business, to debit payments from my specified Credit Card, and I/we acknowledge that Ezidebit will appear as the merchant on my credit card statement. Furthermore, I/we agree to reimburse and indemnify Ezidebit for any successful claims made by the Card Holder through their financial institution against Ezidebit.

Fees

Direct Debit - EFT - No transaction fee!VISA (+1.5% (min 99c) additional transaction fee)Mastercard (+1.5% (min 99c) additional transaction fee)Amex (+5% (min 99c) additional transaction fee)Diners (+5% (min 99c) additional transaction fee) Pay by bank account direct deposit and we'll cover the transaction fee for you.

All transaction fees are taken directly by Ezidebit.

Payment Method