Merrithew Health & Fitness

Specialty Tracks Designation Request Form



First Name * :

Last Name * :

Email * :

Phone (day) * :

Phone (night) :
Do you hold at least one STOTT PILATES Certification?
If yes, please specify :
Address * :

City * :

Country * :

State/Province * :
Zip/Postal Code * :

I have completed a minimum of eight workshops in each (or any) of the following categories:
Athletic Conditioning










Golf Conditioning



Post-Rehabilitation Conditioning






Active for Life





Pre- & Post-Natal



Group Matwork













Group Equipment







Dance







Specialist Designation and Certificate: Only available to Certified Instructors. We are conscious about issues facing the environment, and are making a concerted effort to reduce the use of paper in communication. Upon completion of the Specialty Track, we will provide your certificate as a PDF, free of charge. If you would like to purchase a hard copy of your Specialty Track Certificate, you may do so for a processing fee of $15 per certificate. For printed certificates, please allow 30 days for processing and shipping.