*Manuals and Study Materials are Non-refundable & are required for enrollment in the certification.
Agreement for Enrollment Signature__________________________________________________
I understand that I am responsible for completing the class I am registered for. I understand that for the distance learning program the study materials and manual are non-refundable. In the event, I cannot complete the course due to medical reasons, I will only receive a refund of certification cost (not study materials) if the written exam has not been mailed to the proctor. If the written exam has already been mailed by my request, then my refund would be $15 than the certification to cver mailing and material cost of the test. Proof of medical problem will be required.
Make Check or Money order Payable to A-PAI
547 WCR 18 Longmont, CO 80504
Credit Card # _______________________________________________Expiration Date_________________
Name as it appears on Card_________________________ Signature___________________________________
Billing Statement Zip Code___________________________Circle One MC Visa AmExp Discover
Your Name_______________________________ Proctor’s Name_________________________________
Address__________________________________ Address_______________________________________
City__________________State____Zip_________ City_______________________State____Zip_________
Home Phone ( )__________________Work Phone ( )__________________
Fax ( )__________________E-mail_____________________________
LAND Aerobic Certification ($100) Manual and Study Materials*($75)
Total for Certification $175
Combined Land & Water Certifications ($125)Manual and Study Materials*($125)
Total for Certification $250
Make Check or Money order
Payable to A-PAI
547 WCR 18
Longmont, CO 80504
Credit Card # _____________________________________________Expiration Date___________
Name as it appears on Card __________________________________Billing Statement Zip Code____________
Signature
Circle One
MC Visa AmExp Discover