Licensee Information
Contact Name *
Contact Name
Address *
Address
Phone *
Phone
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Organization/Licensee Information
Have you or your organization ever filed for bankruptcy? *
Are you a certified fitness trainer? *
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a licensee, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
Date *
Date
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in licensing Go Fetch Run.