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Instructor Information Update Form

Don't fall off our radar! Fill out the form below to ensure we have your latest coordinates.  We promise to keep you up-to-date on exclusive discounts and promotions for STOTT PILATES® Certified Instructors.


Name

First Name:*

Initial:


Last Name:*


Home Address


Street Address:*



City:*


State/Province: (required for U.S. & Canada)


Country:*


Zip/Postal Code:*


Company/Studio Address


Street Address:



City:


State/Province: (required for U.S. & Canada)


Country:


Zip/Postal Code:


Position at Company/Studio:

Contact Information

Email:*


Home Phone:*


Cell Phone:


Work Phone:*
  ext.

Courses Taken

Check all that apply.
Level 1 Courses Advanced Courses Rehab Instructor Trainer












Additional Information

What other organization(s) are you certified with?
   

Would you like more information?

Do you have any additional comments?


If you do not wish to receive any communication from Merrithew Health & Fitness™, please indicate below:


At Merrithew Health & Fitness, we are committed to protecting your privacy. We use the information we collect from you to process orders, maintain your CEC records and to keep you informed about our products and services. From time to time we make our customer lists available to official STOTT PILATES Education Partners. If you would prefer that we not pass your name on, please indicate below or email privacy@merrithew.com.



Your responses will be kept confidential. Responses will only be used to update our records.