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2018 Kettlebell AMPD Instructor Convention Registration (Payment Plan)
Thank you for your interested in the 2018 Kettlebell AMPD Instructor Convention!! Please complete all of the information below. Fields marked with '
*
' are required to complete your registration.
Personal Information
First Name
*
Last Name
*
Street Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Email Address
*
Basic Registration Options
A $10 administrative fee for the payment plan option will be due now
. All other options below will be included in your payment plan.
Registration Type
*
Standard Registration - $289
Late Registration (after Jan 31, 2018) - $319
Pre-Convention Options (Friday March 9, 2018)
9 AM - 5 PM
*
AMPD Power Flow Pre-Convention Certification (New Instructor) - $249
AMPD Power Flow Pre-Convention Certification (Existing Kettlebell AMPD Instructor) - $159
Kettlebell AMPD Pre-Convention Certification (New Instructor) - $249
Kettlebel AMPD Pre-Convention Certification (Existing AMPD Power Flow Instructor) - $159
None
10 AM - 12 PM
*
AMPD Resistance Certification - $50
None
1 PM - 4 PM
*
Kettlebell AMPD Unplugged Certification - $69
None
Convention Options (Saturday March 10, 2018)
All Saturday sessions are included in your registration costs. Optional sessions below are at an additional expense.
1 PM - 3 PM
*
Kettlebell AMPD Boost Certification - $25
None
Post-Convention Options (Sunday March 11, 2018)
9 AM - 5 PM
*
AMPD Power Flow Post-Convention Certification (New Instructor) - $249
AMPD Power Flow Post-Convention Certification (Existing Kettlebell AMPD Instructor) - $159
Kettlebell AMPD Post-Convention Certification (New Instructor) - $249
Kettlebel AMPD Post-Convention Certification (Existing AMPD Power Flow Instructor) - $159
None
Payment Information
The information entered below will be used to setup an automatic payment plan. Please note that all payments must be completed by
February 28, 2018
.
Please select the payment frequency that you would like to have your credit card charged:
*
Weekly
Bi-weekly (every 2 weeks)
Monthly
Please select the date on which you would like your first payment charged to your credit card
*
🛈
+
Credit Card Number
*
Expiration date
*
🛈
Security Code
*
🛈
I authorize You Rock Fitness, LLC (parent company of Kettlebell AMPD) to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the services described above, for the amount indicated above only, and is valid for recurring payment indicated above only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Please sign below using your mouse:
*
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