Teacher Certification Program
Registration
Please fill out and check in
appropriate places and mail to the
studio at the address below. If you
have any questions, please call 323
653-1981. Thank you!
Summer Semester: (May9 - Oct 1'05)
________
Date: ____________
Name:___________________
Address:_____________________________________________
City:
________________________State______ Zip ________
Cell Phone:
___________________________
Home Phone:_________________Fax:___________________
Email:_____________________________________________
MAKE ALL CHECKS PAYABLE TO: My
Pilates Body
Full Payment: $3800_____
Assessment: $50_____
5 Privates: $250 (26% discount)
_____
Mandatory if no prior experience on
Pilates equipment.
After assessment of experience
level, student still may be mandated
to purchase a minimum of 5 private
sessions depending on course
instructor's recommendation.
Installment Plan: $4,000 ________
Due now at time of Registration:
$1,200 _______
4 ($700) Installments due prior to
each Weekend Workshop I, II, III,
and IV.
We require a major credit card on
file, and a credit card
authorization to charge any amount
in default of above payment plan
agreement, and a copy of a valid
Driver's License.
MC/VISA:_________________________________________
Expiration Date:
____________________
I authorize My Pilates body to
charge my credit card in accordance
with this agreement.
Signature_____________________________________Date:
______
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