Complete this form for
registration
YES,
please reserve ____ places for the NIHS course listed below
____ Level I Personal Fitness
Specialist Certification for Personal Trainers ($299)
____ Level II Personal
Training Hands-on Course ($245)
____ Senior Fitness/ Special
Populations Specialist ($299)
____
Specialist Certification ($375)
____ Please mail my manual
early for $5.00 additional S and H
Your
Name:
_____________________________________________________________
Address:
_______________________________________________________________
City,
State, Zip:
__________________________________________________________
Phone:
_______________________ Mobile
___________________________________
Email:
_________________________________________________________________
Other
Attendee Name:
____________________________________________________
Other
Attendee Name:
____________________________________________________
Other
Attendee Name:
____________________________________________________
Other
Attendee Name:
____________________________________________________
Other
Attendee Name:
____________________________________________________
I
have selected below my preferred payment option:
____Check: Make checks
payable to National Institute of Health Science LLC
____Cash:
____ Credit card Sign Up On Line
____Visa ____ MasterCard Other
____________________
#
___________________________________
Name
on card: ________________________________ Expires:
__________________
Billing
Zip: _____________ Your Three Digit Code _____________
Signature:
_______________________________ (Use if not using Paypal
System)
Discounts: I am brining four
other trainers and myself. I’ll attend the certification for a $50
discount per person from the advertised
price.
