Name: _____________________________________________________

Address: _____________________________________________________

City/State/Zip: _____________________________________________________

Phone: _____________________________________________________

Your Profession: _____________________________________________________

SELECT A COURSE

Certification Courses:

Weight Training for Rehab, Function and Fitness
Certification: CWT - Certified Weight Trainer

Strength Training Program Design
Certification: STS - Strength Training Specialist

Strength Training for Seniors
Certification: CSST - Certified Senior Strength Trainer

Additional Courses:
Functional Exercise Training
Pilates Fundamentals for Rehab, Function and Fitness
Pilates on the Ball
An Introduction to Yoga

Course Location and Date: _____________________________________________________

Name of friend(s) if registering for group/friend discount of $20: (Friends must submit separate registration forms.)
_____________________________________________________

PAYMENT AMOUNT

1. Course Fee:
   $269 (Functional Exercise Training only)
   $249 (Functional Exercise Training - Save $20 if registering with a friend. Must provide friend(s) names above.)
   $249 (All other classes except Functional Exercise Training)
   $229 (Save $20 if registering with a friend for all classes except Functional Exercise Training. Must provide friend(s) names above.)

2. Standard Homestudy Textbook Shipping Fee: $10

3. Total Fee: $______________
   (Your Total Fee is your course fee PLUS the textbook shipping fee.)

SELECT PAYMENT METHOD

Credit Card #: _____________________________________

Expiration Date:___/____

Authorized Signature: _________________________________

Please note: class sizes are limited and there are no cash refunds once registered. A credit for a future course may be issued if notification is given at least 30 days prior to the day of the course.