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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 information. We promise to keep you up-to-date on exclusive discounts and promotions for MERRITHEW Certified Instructors.

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Personal Infromation

Initial :
First Name * :

Last Name * :

Contact Information

Email:*

Home Phone * :

Cell Phone :

Work Phone :
  ext.

Home Address

Street Address Line 1 * :

Street Address Line 2 :

City * :

Country * :

State/Province * :
Zip/Postal Code * :

Company/Studio Address

Street Address Line 1:
Street Address Line 2:
City :
Country :

State/Province :
Zip/Postal Code :
Position at Company/Studio :

Courses

Please indicate corses you've 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?

At MERRITHEW™, 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 MERRITHEW™ Education Partners. If you would prefer that we not pass your name on, please indicate above or email privacy@merrithew.com.

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