IWA COURSE REGISTRATION FORM

Please print out this form and fax it with your credit card information, or simply mail it with a check to the address below. Registration confirmation letters will be sent 21 days prior to the day of the course with course materials and location directions.

Name: _____________________________________________________

Address: _____________________________________________________

City/State/Zip: _____________________________________________________

Phone: _____________________________________________________

Your Profession: _____________________________________________________

How did you hear about us?
Referred by friend/colleague
Received flyer in mail
Repeat customer
Saw ad on Google
Saw ad on Craigslist
Saw ad in magazine

Other: _____________________________________________________

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
Current Concepts, Lower Back

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 and Lower Back courses only)
    $249 (Functional Exercise Training and Lower Back courses - Save $20 if registering with a friend. Must provide friend(s) names above.)
    $249 (All other classes except Functional Exercise Training and Lower Back)
    $229 (Save $20 if registering with a friend for all classes except Functional Exercise Training and Lower Back. Must provide friend(s) names above.)

  2. Total Fee: $______________

SELECT PAYMENT METHOD

Check VISA Mastercard Discover

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.

IWA, Inc. | 31723 Leeward Court | Avon Lake, OH 44012
440-933-3890 | 1-800-WEIGHTS | FAX: 440-933-3800