SELECT CITY / DATE IN THE SCROLL DOWN BOX BELOW, FILL OUT CREDIT CARD INFO   COMPLETE REGISTRATOIN BY CLICKING THE "SUBMIT" BUTTON AT THE BOTTOM OF THE PAGE. THANK YOU!   Safety Certified Workshop $200.  All Registrations are Final.  There are no refunds / credits for missed workshops.  Thank you.
	Credit Card Authorization:   FULL NAME EXACTLY as it reads on Credit Card Credit Card Number   Select CREDIT CARD you are using in scroll box below  CREDIT CARD TYPE Visa MasterCard American Express Discover   Expiration Date 3 Digit Security Code  (4 Digit on Amex)   BILLING ADDRESS (The EXACT Address your Bill is mailed to for this Credit Card transaction)   Name  (if different from above)  Street Address  Apartment Number / Suite  City / Town  Zip Code
Your Contact Information (required):
	YOUR CONTACT INFORMATION (required)   YOUR FULL NAME (If Different From Above ) YOUR PHONE NUMBER (Please include area code / country code) E-MAIL ADDRESS
	Anything you wish to tell us (including Scholarship / Gift Card Info):   READ BEFORE SUBMITTING YOUR REGISTRATION if you have any questions call us at 1-631-777-7800  We are always proud to serve you.  Thank you.    ALL REGISTRATIONS ARE FINAL.  ALL PROGRAM DATES, TIMES, LOCATIONS, PRICES AND CONTINUING EDUCATION STATUS ARE SUBJECT TO CHANGE.  New York Strength Inc. / Dr. Jack Barnathan p.c. reserve the right to cancel or postpone the seminar or change speakers without notice.  New York Strength Inc. / Dr. Jack Barnathan P.C. cannot be held responsible for any expenses incurred by registrants if a program must be altered or cancelled.  Confirmation: If you have not received confirmation within 48 hours of submitting your application to attend a seminar / workshop, you must call New York Strength Inc. at 1-631-777-7800 to confirm your registration.  Submission of an application does not guarantee a space at the seminar.  In the event the seminar is sold out, we will return your payment.  We cannot hold a space in the seminar if we have not received payment in advance.  Cancellations: All registrations are final.  There are no refunds or credits available for students who miss or are unable to attend the seminar for whatever reason.  All program dates, times, locations and specific topics and continuing education status of each seminar are subject to change.  Group registrations must be paid with one payment and is subject to the cancellation policy.  Continuing education credits for Fitness Trainers and Doctors of Chiropractic can vary from seminar to seminar and are not guaranteed.  You MUST contact our office to confirm the continuing education status of your specific workshop. C L I C K  B O X  B E L O W TO COMPLETE YOUR REGISTRATION.