National Personal Training Institute

3496 Snouffer Road
Suite 100
Columbus, OH 43235
ph: (800) 960-6294
fax: (614) 336-2675
maureen@nptifitness.com

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Enrollment Form

Enrollment Form

You may also click here to download a copy of the enrollment form. The enrollment form, along with payment of the $75.00 enrollment fee (made out to NPTI) should be mailed to :

NPTI

3496 Snouffer Road, Suite 100

Columbus, Ohio 43235

*First Name:

*Last Name:

*Email:

*Phone:

*Address Line 1:

Address Line 2:

*City:

*State/Province:

*ZIP/Postal Code:

*Date of Birth:

*How did you hear about our program:

*Have you attended an open house or an individual appointment:

Yes No

*Have you been convicted of a felony:

No Yes

*Campus Location:

Cleveland (Richmond Heights) Columbus

*Class Schedule:

Day Class: January 9-June 28, 2012 Day Class: April 9-October 4, 2012 Day Class: July 9, 2012-January 3, 2013 Day Class: October 8, 2012-April 4, 2013 Night and Saturday Class: January 10-August 25, 2012 Night and Saturday Class: May 8-December 22, 2012 Night and Saturday Class: September 4, 2012-April 27, 2013

*Payment Option:

Pay In Full Two One-Half Payments Monthly Payment Plan GI-Bill Other

*How will you pay the enrollment fee-
(You will not be enrolled until your enrollment fee payment is received and processed):

Check or Money Order. Please make payable to NPTI and send to: 3496 Snouffer Road, Suite 100, Columbus, Ohio 43235. Credit Card. (Please fill out your credit card information below).

Name on Credit Card:

Credit Card Billing Address:

Credit Card Billing Phone Number:

Credit Card Number:

Expiration Date:

Card Identification Number (CID):

Amount to Charge to Card:

Submit Form:

By submitting this form you certify that all the information contained in this enrollment form is true and complete.

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3496 Snouffer Road
Suite 100
Columbus, OH 43235
ph: (800) 960-6294
fax: (614) 336-2675
maureen@nptifitness.com