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Workshop Dates  |  Location  |  Cost


First Name *
Last Name *
Address *
Apt/Suite
City *
State *
Zip code *
Email Address *
Best Contact Number *
Billing Address *
Is Billing Address same as Personal Address?
First Name *
Last Name *
Address *
City *
State *
Zip Code *

Profession *
Group Fitness Instructor
Personal Trainer
Physical Therapist
Physical Therapy Assistant
Occupational Therapist
Massage Therapist
Athletic Trainer
Studio Owner
Other

Do You Need To Satisfy Any Continuing Education Requirements? Yes  No

Payment Information
Card Type *
Credit Card Number *
Expiration Date * Month :   Year:
Name on Card *
Security Code[CVV Code]*     Billing Zip Code *

How did you hear of us? *
 Mailer
 Gym Flyer
 Referral
 ACE
 NSCA 		 Internet
 E-mail
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 Other
Referred by:
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CANCELLATION POLICY: All sales are final, however transfers are allowed for a $49 processing fee.

SCHEDULE CHANGES: PIA has the right to cancel or re-schedule any advertised workshop for any reason. Students will be offered free transfers or refunds for any workshops cancelled by PIA.

REFERRAL POLICY: Our referral policy allows everyone to earn money back when referring friends. A 10% rebate will be sent to you when your friend signs up.

Pilates Training, Exercises, Classes in Florida, New York, New Jersey and Chicago
© Copyright 2008, Pilates Institute of America, Inc.