Instalments. Name * First Name Last Name Email * Phone * Country (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country I would like to request an instalment payment option for course * Drama Immersion Intro To Acting Performance On Stage Option Theatre Sport Emergency Contact Name * First Name Last Name Emergency Contact Number * Country (###) ### #### Relationship to Emergency Contact: * Parent Guardian Spouse/Partner Sibling Friend Roommate/Housemate Option Relative (Other) Grandparent Aunt/Uncle Cousin Employer Co-worker Neighbour Doctor/Health Provider Carer/Support Worker Legal Representative Any Acting Experiance Yes No If yes, please provide details about your acting experience How would you describe your acting? Beginner Intermediate Professional I Don't Know Do you have any medical conditions we should be aware of? * Yes No If yes, please provide details about your medical condition(s) Do you have any allergies? Yes No If yes, please list your allergies and any necessary precautions we should take: agree with the Terms And Conditions * * https://www.stage61.com.au/privacy-policy-1 Yes Thanks for reaching out! We’ll contact you as soon as possible with the instalment details.
