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Extension Form

Please complete all appropriate fields below. Shaded fields are required.

Name of Home or Host Advisor:
First Name:
Last Name:
Street Address:
City, State/Province:
ZIP/Postal Code, Country:
Phone:
Email:
Effective Dates:	Start Date to End Date

Extensions have a $175 USD fee. Please contact Pace (pace@thepilatescenter.com) to make payment arrangements.

I hereby acknowledge and agree that I am extending my Teacher Training Program for one month. I have paid all monies currently due to The Pilates Center, and will keep my accounts current during my extension. I understand that if my program expires I must purchase an extension or I will automatically be withdrawn.

Additionally, I understand that if the cost of any part of the Teacher Training Program or The Pilates Center studio fees should change during my extension I will be required to pay the current pricing.

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

2017-02-07 14:46:41 MDT

Extension Form Uploaded by Rachel Taylor Segel - forms@thepilatescenter.com IP 50.194.156.193, 50.194.156.193