Wufoo
Urban Poling Course Registration
Name
First
Last
Email
*
Phone Number
###
-
###
-
####
Website
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
----
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Democratic Republic of the Congo
Republic of the Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Select a Course
TBA - New Brunswick
February 26, 2012, 10:30 to 2:30 - Toronto
March 25, 2012, 10:30 to 2:30 - Toronto
April 1, 2012, 10:00 to 1:00 - London
April 1, 2012, 1:30 to 4:30 - London (Level 2)
April 13, 2012, 12:00 to 4:00 - Gravenhurst
April 14, 2012, 9:00 to 1:00 - Huntsville
April 25, 2012, 1:30 to 4:30 - Webinar (CARA Recreation Activators)
May 5, 2012, 12:30pm - 4:30pm - Mississauga
May 6, 2012, 10:30 to 2:30 - Toronto
June 10, 2012, 9:00 to 1:00 - Toronto
Sept. 9, 2012, 10:30 to 2:30 - Toronto
Sept. 23, 2012, 10:30 to 1:30 - Toronto (Level 2)
October 14, 2012, 10:30 to 2:30 - Toronto
Secrets to Success - Audio Course, Transcript & Resources
COURSE OPTIONS
Certification Course Level 1 - OPTION 1 : course, manual & Series 300 Fitness poles/DVD = $230 + $29.90 HST = $259.90
Certification Course Level 1 - OPTION 2: course, manual, Series 300 Fitness poles/DVD, carrying bag, extra boot tips = $260 + $33.80 HST = $293.80
Certification Course Level 1 - OPTION 3: course, manual, Adventure poles/DVD, carrying bag, extra boot tips = $275 + $35.75 HST = $310.75
Certification Course Mississauga - course & manual only = $145 +$18.85 HST = $163.85 (price for Miss. staff only/discounted poles available at course)
Certification Course Level 2: course & manual = $90 + $11.70 HST = $101.70
Secrets of Success - Audio Course - Audio download, Transcript & Resources $40 + $5.20 HST = $45.20 (course emailed once payment received)
PAYMENT OPTIONS
Cheque: Complete and submit this form. Mail cheque (payable to CustomFit) to 244 Bain Ave., Toronto, ON, M4K 1G3
Credit card: Complete and submit this form. Call me or I will call you for credit card info.
How did you hear about this course?
*
Do Not Fill This Out
Wufoo
Powered