Fitness Industry Register Practitioner Registration Form

* Indicates Required Field

*First Name

*Last Name

*Address

*City

*State/Province/County

*Country

*Postal Code

*Email

*Telephone

Work Phone

Mobile/Cell

Fax

Website Address

Gender

Male
Female

Are you a
self-employed
fitness
professional?

Yes
No

Do you have liability insurance?

Yes
No

Geographical area
or locations
you cover.
(Radius in miles
from address)

In 50 words or less write a short piece about yourself.
(This will be used for your description)

Please enter your qualifications and the years they were achieved,
and select your other fields of expertise below.

Your minimum hourly rate.
(Be aware that clients do tend to
opt for cheaper options as
opposed to experience.
Avoid pricing yourself out
of the market)

Questions/Comments

I acknowledge that all of the above listed information is true and correct.