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Questionnaire
First Name *
Middle Initial
Last Name *
Email *
Address *
City *
State/Province *
Zip code *
Country *
Phone number
Website
Are you a fitness professional?
Yes
No
Specialty *
Are you a 4 year degreed fitness/allied health professional?
Yes
No
Degree Name *
Are you currently certified? if Yes choose one or more.
Yes
No
AFAA
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
ISSA
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
NASM
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
ACE
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
ACSM
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
NSCA
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Certification Type
Certification Number
Certification Expiration Date
Other
Other Certificate
Where can we verify your certification?
Do you have Professional Liability insurance?
Yes
No
Company Name *
Date of Expiration *
Are you referred by an organization or institution?
Yes
No
Organization or institution name *
Are you affiliated with a health club?
Yes
No
Facility Name *
Facility Email *
Facility Address *
City *
State/Province *
Zip code *
Country *
Facility phone number
Do you opt-in to receive emails and other promotional notifications?
Yes
No
Social Media
Facebook
Instagram
Twitter
Pinterest
Tiktok
LinkedIn
Other Social
Do you want your comments to be anonymous in our Ratings Effectiveness System?(CREATORS ONLY)
Yes
No
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