Printable Registration Form - SCW Fitness

egistration form■■■■■■■■■■■■■■■namePre-Convention Certifications / Specialty Certificates, Masterclasses, Workshops. Check all that apply.WEDNESDAY, MARCH 26, PRE-CONVENTION CERTIFICATIONS/SPECIALTY CERTIFICATES(late fee after 03/14/08 add $40, add $60 on-site)MANIA ConventionAttendees by 03/14/08MANIA ConventionAttendees by 03/14/08SCW Moms in Motion Pre/Postnatal Specialty Certificate with Megan Flatt7:00am-5:00pmExam Fee■ $139■ $35■ $179■ $35(Materials included) ■ $8 (+s&h) ■ $8 (+s&h)SCW Personal Training Certification with Douglas Brooks, MS7:00am-5:00pmExam Fee■ $99■ $35■ $149■ $35SCW Group Exercise Certification with Gay Gasper7:00am-5:00pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training Manual, Product Code #B29 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW Pilates Matwork Fundamentals Specialty Certificate with June Kahn7:00am-7:00pmExam Fee■ $99■ $35■ $149■ $35Training Manual, Product Code #B26 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW Sports Nutrition Specialty Certificate with Dominique Adair, MS, RD8:00am-5:00pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training Manual, Product Code #B41 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW Yoga Fundamentals I Specialty Certificate with Lawrence Biscontini, MA7:00am-5:00pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training Manual, Product Code #B37 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW FlowingYoga Fundamentals I with Deirdre Daniels5:30pm-9:30pm ■ $69 ■ $99Exam Fee ■ $35 ■ $35Training Manual, Product Code #B2 ■ $19.95 (+s&h) ■ $19.95 (+s&h)WE2A Outdoor Fitness Boot Camp Instructor Certifications with Mari Garner5:30pm-9:30pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training Manual ■ $19.95 (+s&h) ■ $19.95 (+s&h)THURSDAY, MARCH 27, PRE-CONVENTION CERTIFICATIONS/SPECIALTY CERTIFICATES(late fee after 03/14/08 add $40, add $60 on-site)SCW Aquatic Exercise Fundamentals Certification with Irene McCormick, MS, CSCS7:00am-6:30pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training Manual, Product Code #B11 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW Group Step Specialty Certificate with Gay Gasper7:00am-12:00pm ■ $59 ■ $89Exam Fee ■ $35 ■ $35Training Manual, Product Code #B32 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW Group Strength Specialty Certificate with Gay Gasper1:00pm-6:00pm ■ $59 ■ $89Exam Fee ■ $35 ■ $35Training Manual, Product Code #B49 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW 100% Hands-On Personal Trainers Certification with Douglas Brooks, MS8:00am-5:00pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training DVD ■ $39.95(+s&h) ■ $39.95(+s&h)SCW Pilates Matwork Small Apparatus Specialty Certificate with Leslee Bender9:00am-5:00pm ■ $99 ■ $149Exam Fee ■ $25 ■ $25Training Manual, Product Code # B40 ■ $19.95(+s&h) ■ $19.95(+s&h)SCW Weight Management Specialty Certificate with Dominique Adair, MS, RD8:00am-6:00pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training Manual, Product Code # B61 ■ $19.95 (+s&h) ■ $19.95 (+s&h)SCW Yoga Fundamentals II Specialty Certificate with Deirdre Daniels7:30am-6:30pmExam Fee■ $99■ $35■ $149■ $35Training Manual, Product Code # B12 ■ $19.95 (+s&h) ■ $19.95 (+s&h)(877) SCW-FITT (847) 562-4020 fax (847) 562-4080 pg. 37

egistration formMANIA ConventionAttendees by 03/14/08MANIA ConventionAttendees by 03/14/08■■■■■■■■SCW T'ai Chi and Qi Gong For Wellness Professionals with Lawrence Biscontini, MA7:30am - 6:30pm ■ $99 ■ $149Exam Fee ■ $35 ■ $35Training Manual, Product Code #B5 ■ $19.95 (+s&h) ■ $19.95 (+s&h)TH1A Peak Pilates MVe Instructor Preparation Workshop With Stacey Lei Krauss7:00am-4:30pm ■ $199.95 ■ $199.95TH1B Stamina Pilates Studio Tower Specialty Training 101 with June Kahn8:00am-5:00pm ■ $199 ■ $249TH1C Zumba Basic Skills Training Level 1 Certificate withJessica Thompson & Tony Witt8:00am-5:00pm ■ $190 ■ $210TH1D Urban Striptease Master Training with Tricia Murphy8:00am-12:00pm ■ $69.95 ■ $99.95TH1I SCHWINN ® Cycling Instructor Training Course with Julz Arney & Amy Dixon9:00am-7:00pm ■ $195 ■ $220TH2A Sports Conditioning with Fabio Comana, MS, MA1:00pm-6:00pm ■ $69 ■ $99TH2B IFTA Kickboxing Specialty Certificate with Greg Sims5:30pm-9:30pmTraining Manual■ $99■ (+s&h)■ $129■ (+s&h)friday, march 28■ Friday Masterclasses (Indicate your selection on page 39) ■ $10 ■ $20saturday, march 29■ Saturday Masterclasses (Indicate your selection on page 39) ■ $10 ■ $20sunday, march 30■SU5D Bender Ball Meets Gliding Master Training with Leslee Bender & Mindy Mylrea3:00pm-6:00pm ■ $49 ■ $49cPayment InformationRegistrations will not be accepted without full payment.Select payment method:■ Check / money order / third party payments.Check #______________If paying by check or money order your registration must be mailed to SCW with check / money orderenclosed and made out to: SCW. A check payment made by a third party (employer, club, etc.) MUST haveyour name and the name of the MANIA convention on it even if you have pre-registered by phone. If youpre-register by phone you must send in all registration forms including: credit card signatures, signedInformed Consent and class selections. Registrations received without payment will not be processed.Sorry, no purchase orders.SCW accepts: ■ MasterCard ■ Visa ■ DiscoverCredit Card#_________________________________________________________________Expiration Date___________________________________________________Print Cardholder’s Name_________________________________________Cardholder’s Signature___________________________________________Your signature is required. Your above signature authorizes SCW to charge your credit card.dFee Total Tally up your fees!SCW MembershipMANIA ConventionPre-Con EventsGroups of 10-19 take 10% off SCW Certs on the same registrationGroups of 20+ take 15% off SCW Certs on the same registrationMasterclassesExam Fees / Manuals (if applicable)Shipping and Handling* (if applicable)Total$_______________$_______________$_______________$_______________$_______________$_______________$_______________* Shipping and handling information:Within the continental U.S. USPS ground shipping deadline 3/21/08. Call(877) SCW-FITT or email product@scwfitness.com for international rates orexpress shipping charges. After processing your registration and class selectioninformation, SCW will mail or email your confirmation letter along with yourclass schedule. Badges will be sent with confirmation letter and must bebrought to convention with included waiver informed consent signed. Receiptalso included in the confirmation letter.Please do not make travel reservations until you receive your confirmation.SCW Fitness Education will not be held accountable for pre-paid or non-refundabletransportation deposits. If you have not received your confirmation within2 weeks of your registration, please call (877) SCW-FITT.pg. 38 www.scwfitness.com (877) SCW-FITT ax (847) 562-4080 name

egistration/course selectionfdirections for registration:Fill in the session code letter for yourfirst, second and third choices for eachtime slot. Your session requests will beprocessed on a space available, firstreceived,first-entered basis based onthe date yourfull registrationisreceived(sessionrequests,payment,etc.).Example:fridaySESSION TIME 1st choice 2nd choice 3rd choice9:00am-11:00am 1 _ A ______ _______ N _______ GCourse descriptions and session code letterscan be found on pages 14-29.informed consent important:please read and sign.I agree to hold harmless SCW Fitness Education, their company, owners, director, employees, conferencepresenters, conference sponsors, staff and MANIA sponsors from any and all liability arising out ofthis event including, but not limited to: muscle strains, tears, pulls, broken bones, miscarriage, death, andany and all illness, or loss of my personal property.I understand the risks involved with participating in this strenuous event and may attest that I am in soundphysical condition. I also understand that I may be videotaped, audio-recorded and/or photographed duringthis event and SCW Fitness Education may use the images for any and all purposes. I further agreeto all conditions of registration, including but not limited to the No Refund Policy.SCW may give or rent your email, mailing address and/or phone number(s) to other high-quality healthand/or fitness-related organizations with whom we have a trusted relationship and share common goalsand who meet our criteria for sharing such information.I have read and understand this information.Signature requiredDateREFUND POLICY: NO REFUNDS!Presenters, classes, dates and times are subject to change without notice. We have no refund policy. Once a registration is submitted,it will be processed and can not be refunded for any reason, however a Letter of Credit or Transfer is available. A Letterof Credit is available for a $85 processing fee. All requests for Letters of Credit must be submitted in writing and include the reasonfor cancellation. All requests must be mailed or faxed to SCW or emailed to registration@scwfitness.com. Letters of Creditare valid up to one year from the canceled event. If the Letter of Credit is not used in one year, the amount is forfeited. A Transferof registration to another party is available for a $85 processing fee. Phone requests can be taken for Transfers. Transfers canonly be made if the new party is attending the same convention as the original attendee, and is not already a registered attendee.SCW will not grant Transfers or Letters of Credit after the convention date. SCW Fitness Education is not responsible for acts ofGod, nature, war, union or labor disputes or other events out of our control.sunday, march 30 saturday, march 29 friday, march 28friday, march 28, 2008REGISTRATION DESK OPEN FROM 7:00am-7:00pmRegistration is located in the Hyatt Regency Ballroom Foyer.SESSION TIME 1st choice 2nd choice 3rd choice9:00am-11:00am 1 __________ __________ __________12:00pm-1:30pm 2 __________ __________ __________1:45pm-3:15pmor2:30pm-4:00pm 3 __________ __________ __________4:15pm-5:45pm 4 __________ __________ __________MASTERCLASSES6:45pm-7:45pm 5 __________ __________ __________Additional fee $10 Attendees / $20 Non-Attendees NO CECssaturday, march 29, 2008REGISTRATION DESK OPENS AT 6:00am-7:00pmSESSION TIME 1st choice 2nd choice 3rd choice7:00am-9:00am 1 __________ __________ __________10:00am-11:30am 2 __________ __________ __________11:45am-1:15pmor12:30pm-2:00pm 3 __________ __________ __________2:15pm-3:45pm 4 __________ __________ __________4:00pm-5:30pm 5 __________ __________ __________MASTERCLASSES6:30pm-7:30pm 6 __________ __________ __________Additional fee $10 Attendees / $20 Non-Attendees NO CECssunday, march 30, 2008REGISTRATION DESK OPENS AT 6:30am-3:00pmSESSION TIME 1st choice 2nd choice 3rd choice7:00am-8:30am 1 __________ __________ __________8:45am-10:15am 2 __________ __________ __________11:15am-12:45pm 3 __________ __________ __________1:00pm-2:30pm 4 __________ __________ __________POST-CON WORKSHOPS - Additional FeesTo Select Pre- and Post-Convention classes, see pages 36 and 37.name(877) SCW-FITT (847)(877) 562-4020 SCW-FITT fax (847) • (847) 562-4080 562-4pg. 39