Thank you, and congratulations for taking the first step towards becoming a PACNY Certified Instructor. Upon successful certification, you will join a select group of individuals noted for their unparalleled knowledge and outstanding instruction techniques.

Please take a moment to complete the registration form below, and feel free to contact us with any questions. If you prefer to send us your registration information, you may print the completed form and send it to:

Pilates Associates of Central NY, LLC
Certifications
310 Taughannock Blvd., Suite 2B
Ithaca, NY 14850

or you may fax your registration to:
(607) 330-1763

We will contact you within 24hrs to arrange payment for your selected course(s). Space will not be held without a 50% deposit.

Personal Information

*Today's Date:
(mm/dd/yyyy)

*Full Name:

*TEL:

*Email:

*Address:

*City:

*State:

*Zip:

Returning Client?:

Yes No

*Preferred Contact Method?

We will you contact you via your preferred contact method in order to confirm your space and request payment.

*Select Workshop(s)

Mat I/II

Reformer I/II

Anatomy & Biomechanics Review

Posture Assessmen

Pool-toStudio

AQUALATES®

How did you learn about our certification programs?

Select this box if you would like to receive The PILATES Room email newsletter, "REFORMATIONS" ?

Previous Experience & Goals

*List any previous teaching experience, certifications & anatomy knowledge.

*How do you intend to use your certification? (Pilates Studio, Health Club, Your Own Business)

		The PILATES Room 310 Taughannock Blvd., Suite 2B Ithaca, NY 14850 (607) 330-0957 info@nypilates.info

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