New Student Registration Form

PRIVATE & CONFIDENTIAL for Tai Chi Bali instructor Dave West only.

Please fill in all the boxes below and Submit. Thank you.

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Full Name (same as Passport/ID) *

Nationality (same as Passport/ID) *

Email Address *

WhatsApp Number *

M / F *

Age *

Which dates are you registering for? *

Which Course/Retreat you are registering for? *

Why are you attending this Course/Retreat? *

What is your level of experience & skill in Taichi and Qigong? *

What is your level of health & fitness? *

Do you have any health issues? *

I agree to all Terms & Conditions & Disclaimer stated on the following website: https://taichibali.com/terms-conditions/ YES / NO *

Do you have any questions? *

Anything else you would like to share? *

Submit