Group Fitness Director Autoship Authorization Form



INSTRUCTOR INFORMATION
If you need to remove instructors from your Autoship, please request a report from kelcyrourke@mossa.net.
Please note, this form is not indended for use to register instructors for upcoming trainings. Please use the Training Registration Form to register your instructors. 
 Instructor #1
first name
last name
branch
program(s) to add
 Instructor #2
first name
last name
branch
program(s) to add
 Instructor #3
first name
last name
branch
program(s) to add
 Instructor #4
first name
last name
branch
program(s) to add
 Instructor #5
first name
last name
branch
program(s) to add
 Instructor #6
first name
last name
branch
program(s) to add
 Instructor #7
first name
last name
branch
program(s) to add
 Instructor #8
first name
last name
branch
program(s) to add
 Instructor #9
first name
last name
branch
program(s) to add
 Instructor #10
first name
last name
branch
program(s) to add

CONTACT INFORMATION & PAYMENT:
Please fill in the following information of the person filling out this form.
 
By filling in the information below you accept that you are authorized by the facility to make legal decisions on their behalf.

Billing Information

Please enter your credit card information below to be billed on your credit card. The Accounting Contact listed below will receive receipts/invoices.