Dancing Thru Pregnancy: Registration

First Name:
Last Name:
Mailing Address:
Mailing Address 2:
City:
State:
Zip or Postal Code:
Email:
Website:
Phone:
Fax:

Location:
Dates:

Year:
Institution or Professional Or:
Degree major and or certific:

Basic Pre and Post 299 / 329:
Renewal 35:

Licensee U.S. 300:
Name of Licensee:
Licensee Phone:
Licensee Email:

DTP Advance Certification 325:
Advanced Cert Renewal:

Please charge my Visa or MC:
Expiration:
If non US CC VPN number:

Billing Address if different:
Billing Zipcode:

Basic Seminar Ebrochure:
Licensing and Cert Ebrochure:
Contact Consultation:

If you would like to order Women's Fitness Program Development, go to HumanKinetics

If you would like information on the DTP/SA Instructor training, contact: dtp-sa@dancingthrupregnancy.com

Refunds on Seminar Registrations:	Waiver of Liability:
Refunds of fees minus materials and administrative costs are $80 Basic and $110 DTP® Licensee/Certification are available up to 10 days prior to the seminar. If you are unable to attend, fees may be applied to a later seminar date.	I understand the risks of physical activity, and waive Dancing Thru Pregnancy®, Inc.'s liability for these risks during my participation in the seminar(s) for which I have registered. My registration constitutes acceptance fo these terms.

If you prefer not to pay online, print this form and mail with check made out to DTP, Inc. or credit card number to our office: DTP, Inc. / Box 3083 Stony Creek, CT 06405 USA, or call 1-800-442-9034.