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Black Yoga Bae

First Name *

Last Name *

Phone *

Your E-Mail Address *

Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Membership	x $80.00	$80.00 per month
Total: $80.00

Memberships are auto-debited monthly on the date of purchase. Memberships may be cancelled by the client anytime.