Employment Training Space Trainer Registry Volunteer
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
CELL/ PAGER:
EMAIL:
LIST CERTIFICATIONS Please include how long you have been certified and when your certification expires.
SPECIALTIES
INSURANCE
Provider:
Limits:
Policy No.:
CPR CERTIFICATION
How long have you been certified?
When does your certification expire?
How long have you been a Personal Trainer?
Rate charged per hour?
Do you have a Web site? Yes No
If "YES", would you like to include a hyperlink to your site?
Yes No
What is your training philosophy?
Please provide three (3) personal or professional references.
(1) Name:
Relationship:
Address:
Contact Phone:
(2) Name:
(3) Name:
