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CERTIFICATION RENEWAL FORM
Print and fill out this form to renew your current certifications. You can fax this form to us at 866-264-1762, or mail it to us at:
ISFTA, Inc. P.O. Box 51362 Sarasota, FL 34232
Name:______________________________________
Address:____________________________________
______________________________________________
Phone:________________________ E-mail:______________________
Certifications you wish to renew:
O Certified Personal Trainer - $89
O Master Level Trainer - $89
O Advanced Personal Trainer - $89
O Rehab Fitness Trainer - $89
O Fitness Nutrition Specialist- $10
O Plyometrics Training Specialist- $10
O Fitness Ball Training Specialist- $10
O Pre/Postnatal Fitness Specialist- $10
O Aqua Fitness Specialist - $10
O Senior Fitness Specialist- $10
O Corporate Fitness Specialist - $10
O Youth Athletic Perf. Specialist- $10
O Exercise Physiology Specialist - $10
O Other (List on Page 2)
Documents to be included with renewal application:
Copy of current CPR card
Copy of all CEU certificates (20 hours total)
Renewal fee
Copy of current certificationsFee Breakdown:
Certified Personal Trainer - Advanced Personal Trainer – Rehab Fitness Trainer – Master Level Trainer --- $89.00 per 2 year period (Only one fee applies for any of these levels)
Specialist Classes --- $10.00 Per each specialist class being renewed
Late fee –
If application is submitted more than 90 days past the expiration date then there is an additional late fee of $25.00. Only one late fee charge regardless of how many certifications are being renewed.
Payment Information: O Check O Money Order O Credit Card
Name on credit card:_____________________________________________
Billing Address:_________________________________________________
______________________________________________________________
Card Number: _________________________________________________
Expiration: ______/______ Security number:__________
Total Amount to be billed on card: __________________________________
This section for ISFTA use only:
Date Received:___________________
Date Processed: ___________________
Processed by: ________________________________
Requirements met: YES / NO
New Exp. Date: ______________
Payment Cleared Date: ____________
Date Mailed: ________________