CERTIFICATION FORM CERTIFICATIONS RADICAL FITNESS AUSTRALIA 2017 REGISTRATION FORM Radical Fitness Australia is offering all New and Exciting Instructors a great way to achieve your goals by becoming an Instructor and making your dreams a reality. When registering for any of our Certifications, pay just 50% of the certification price and the remaining balance 30 days after the Certification date, interest FREE. *A receipt will be issued when full payment has been received. Radical Fitness programs are registered with Fitness Australia and 15 CEC points will be issued upon passing of the Certification. ***************************************************************************************** I WANT TO REGISTER IN THE CERTIFICATIONS FOR THE FOLLOWING PROGRAMS:: br FIGHT DO POWER X55 KI MAX OXIGENO TOP RIDE U BOUND MEGADANZ RADKIDZ FACTOR F ***************************************************************************************** I WOULD LIKE TO DO A REFRESHER FOR THE FOLLOWING PROGRAMS:: br FIGHT DO POWER X55 KI MAX OXIGENO TOP RIDE U BOUND MEGADANZ RADKIDZ FACTOR F *Registrants must complete the whole Certification (whether 2 or 3 days) for the Refresher to be valid, which is FREE to all current Official Trainers. ***************************************************************************************** Radical Official Trainer Fitness Instructor Radical Licensed Club Staff/Owner Other Radical-Licensed / Other Club(s): Personal Details First Name Surname: Street Address: Suburb: City: State: Postcode: Home phone: Mobile: Email: ***************************************************************************************** PAYMENT OPTIONS - I wish to pay by: br> 1. CHEQUE //// - Please make cheques payable to: Radical Fitness Australia Send to: RADICAL STATION 497 Hutt Rd Lower Hutt 5010 NEW ZEALAND 2. CREDIT CARD //// Payment: For secure credit card payments please phone: 1300 492 144 3. BANK TRANSFER - DEPOSIT //// RADICAL FITNESS AUSTRALIA PTY LTD ANZ BANK BSB: 012 341 ACC #: 284 197 561 Particulars: RF Cert Ref: Your Name ***************************************************************************************** A confirmation email will be sent to you notifying registration has been received. If however you do not receive this within 48hours please contact us at the number below. Contact us: PHONE: 1300 492 144