Pilates Instructor Training Registration Form

To register, please fill out this online form. You can also call to register at 877-PILATES (877-745-2837), fax in this form to 916-388-0609, or mail it to:

Balanced Body University
Attn: Education Coordinator
8220 Ferguson Ave
Sacramento, CA 95828

Yes! Please sign me up for a PMA Student Membership $35 (regularly $50) [more info].

Educator: Movements Afoot, New York, NY

1. Select Classes

Trapeze Table, Chair and Barrels: Module 3, Movements Afoot: 9/11/2010-9/12/2010 $450.00 [Prerequisites: Trapeze Table, Chair and Barrels: Module 2]

Mat 1 Module, Movements Afoot: 11/13/2010-11/14/2010 $499.00 [Prerequisites: 1 year experience teaching movement, anatomy, 20 Pilates Mat class sessions]
[Mat 1 Module, **Manual Fee** $50.00]

Mat 2 Module, Movements Afoot: 1/8/2011-1/9/2011 $499.00 [Prerequisites: Mat 1 Module]
[Mat 2 Module, **Manual Fee** $50.00]

Reformer 1 and Movement Principles, Movements Afoot: 2/25/2011-2/27/2011 $499.00 [Prerequisites: 1 year experience teaching movement, anatomy, 30 Pilates Reformer classes or personal training sessions]
[Reformer 1 and Movement Principles, **Manual Fee** $50.00]

Reformer 2 Module, Movements Afoot: 3/26/2011-3/27/2011 $450.00 [Prerequisites: Reformer 1 Module]
[Reformer 2 Module, **Manual Fee** $50.00]

Reformer 3 Module, Movements Afoot: 4/30/2011-5/1/2011 $450.00 [Prerequisites: Reformer 2 Module]
[Reformer 3 Module, **Manual Fee** $50.00]

Trapeze Table, Chair and Barrels: Module 1, Movements Afoot: 6/4/2011-6/5/2011 $450.00 [Prerequisites: Reformer III or Reformer certification]
[Trapeze Table, Chair and Barrels: Module 1, **Manual Fee** $150.00]

Trapeze Table, Chair and Barrels: Module 2, Movements Afoot: 7/23/2011-7/24/2011 $450.00 [Prerequisites: Trapeze Table, Chair and Barrels: Module 1]

Trapeze Table, Chair and Barrels: Module 3, Movements Afoot: 9/10/2011-9/11/2011 $450.00 [Prerequisites: Trapeze Table, Chair and Barrels: Module 2]

Note: California Taxes may apply for manuals, etc.

Already registered with Balanced Body University?

You can pre-fill your billing and shipping information by entering your email and password below.

Email:

Password:

Please enter your information EXACTLY as you want it shown on all correspondance including your certificate of completion. We suggest "David versus DAVID or david"

2. Enter the Contact Information of the person taking the course.

* = Required Field

Attendee First Name*
Attendee Last Name*
Business Name
Street Address*
PO/Suite
City*
State/Province* (US/Canada Only)
ZIP/Postal Code*
Country*
Work Phone
Cell Phone
Home Phone
Fax
	Email Address* *Email (Confirm)**
	Password Password (Confirm)

Check if shipping address and billing address are the same

3. Shipping Address (if different from above)

Note: We can not ship manuals to P.O. Boxes.

First Name
Last Name
Business Name
Street Address
PO/Suite
City
State/Province (US/Canada Only)
Zip/Postal Code
Country

	Credit Card Information
Card Type*
Card Number*
Name on Credit Card
Exp. Date*
Security Code* What's this?

4. Please Tell us about yourself (optional)

Pilates Instructor		Studio Owner
Physical Therapist		Program Manager
Personal Trainer		Student
Other
Other Description
Years Teaching Pilates?
How did you hear about us?
Comments

5. WAIVER AND RELEASE OF LIABILITY (required)[pdf version]
WAIVER AND RELEASE OF LIABILITY – Any participating person (hereinafter ‘PARTICIPANT’) in a training program, physical program, exercise program, class, or any other event (hereinafter collectively ‘TRAINING’) sponsored and/or conducted by, or on behalf of, Balanced Body University LLC, its officers, directors, employees, related companies, successors, assigns, independent contractors, and/or training instructors (hereinafter collectively ‘PROVIDER’), will participate in said TRAINING, including, but not limited to, engaging in physical activity and exercise associated with the TRAINING, and utilizing equipment, instruction, services, facilities, and premises that are part of the TRAINING, entirely and expressly at the PARTICIPANT'S own risk. Further, in express consideration for being permitted to participate in said TRAINING, PARTICIPANT, on behalf of herself or himself, and all successors, heirs and assigns, agrees to completely and forever release and hold harmless PROVIDER from any and all liability for injury, death, damages, any loss to PARTICIPANT and/or the personal property of the PARTICIPANT, as well as any claim, demand, lawsuit, injury, and damage of whatever type or nature (hereinafter collectively ‘CLAIM’), even if caused by acts or omissions, including but not limited to negligence, of PROVIDER. In addition, as further consideration for being permitted to participate in said TRAINING, PARTICIPANT authorizes PROVIDER to take photographs and/or video images of PARTICIPANT (hereinafter collectively ‘PICTURES’) during the TRAINING for use by PROVIDER in advertisements and/or other promotional materials for similar future events. PARTICIPANT hereby expressly consents to such use and forever releases any and all rights that PARTICIPANT has as to his or her image as depicted in the PICTURES, as well as any and all other rights PARTICIPANT may have to the PICTURES. The PARTICIPANT further expressly agrees that the foregoing WAIVER AND RELEASE OF LIABILITY is intended to be as broad and inclusive as permitted by law, and that if any portions of this WAIVER AND RELEASE OF LIABILITY are found invalid for any reason, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Additionally, PARTICIPANT expressly authorizes the use of electronic means to enter into, and evidence, this WAIVER AND RELEASE OF LIABILITY agreement. Further, PARTICIPANT and PROVIDER expressly agree that California law shall apply to any CLAIM arising from the TRAINING and that any lawsuit arising from a CLAIM shall be venued in Sacramento County, California. PLEASE TAKE NOTICE that if the foregoing is acceptable, PARTICIPANT or an authorized agent on his or her behalf must check the above box acknowledging that he or she has read, understood and expressly agrees that PARTICIPANT is bound by the foregoing WAIVER AND RELEASE OF LIABILITY, and then click on the SUBMIT button. PLEASE TAKE FURTHER NOTICE that by checking the above box and clicking the SUBMIT button, any person other than PARTICIPANT is also expressly representing that he or she is the authorized agent of PARTICIPANT for purposes of binding PARTICIPANT pursuant to the terms of the WAIVER AND RELEASE OF LIABILITY and that PROVIDER is relying upon this representation. If it is later determined that the person purporting to bind PARTICIPANT is not, in fact, the authorized agent for PARTICIPANT for this purpose, the person making the representation will defend, indemnify, hold harmless and be personally liable to PROVIDER for all damages incurred by PROVIDER arising from any CLAIM by PARTICIPANT, including but not limited to payment of any judgment, settlement, and the fees and costs of PROVIDER'S attorneys and experts.

I have read and accept the terms and conditions of the liability waiver.

Cancellation Policy

Cancellation of your class will incur the following fees:

$100.00 fee if written notice of cancellation is received by BBU up to five (5) days before class start date or a $50.00 transfer fee to transfer from one course to another course.
$250.00 or the full course fee, whichever is less, if written notice of cancellation is received by BBU within five (5) days before class start date or a $50.00 transfer fee to transfer from one course to another course.
No refund is given for any cancellation received on or after the start date of the training.
NOTE: These policies may not apply to any training offered outside the USA.

To cancel your registration please contact us at: Balanced Body University, 8220 Ferguson Ave, Sacramento, CA 95828 or (877) PILATES or via e-mail at info@PilatesOnTour.com.

Program Changes

Balanced Body University makes every effort to hold classes at the dates, times and locations, and with the instructors and classes specified on our web site and brochures. We do reserve the right to cancel and/or change event dates, times, instructors and locations although this happens very rarely. In the very unlikely event that circumstances dictate that we do postpone or cancel a class, you will be refunded your registration fee in full or offered a transfer to another Balanced Body University class of your choice.

Balanced Body University is not responsible for workshops, or portions of workshops that attendee misses due to illness, emergency, or other event beyond the control of BBU. BBU is not responsible for losses incurred by any attendee for airline fares or other travel arrangements in the event that the class must be cancelled or postponed. Travel insurance is strongly recommended.

Manuals

Please note: Normally BBU ships manuals directly to the indicated shipping address. If you signed up for a class and we do not have enough time to guarantee arrival of your manuals before the class (usually 10 business days), you will be able to pick up your manuals at the training.

ABOUT SSL CERTIFICATES

Receipt

Module:
Manual:
Additional Fee:
PMA:
Tax:
Discount:
Quantity Discount:
Total:

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