Name *
Name
Phone *
Phone
Address *
Address
Date of Birth *
Date of Birth
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(studio/gym atmosphere, instructor/studio owner, part time/full time)
(PoleStar, Balanced Body, etc)
(Include C.E.C's and all course certificates and diplomas)
Please select your present situation *
Did you read the program requirements? *
Did you read/sign the Enrollment Agreement *
How did you hear about us? *