Contact Information:
Full Name:
Email Address:	* required
Phone Number: (include area code)	* required
Profession: (fitness trainer, physician, athlete, etc...)	* required
Credit Card Authorization:
	Full Name (EXACTLY as it reads on credit card)  * required Credit Card Number  * required CC Type Visa MasterCard American Express Discover Expiration Date  * required 3-Digit Security Code (4 digits on AMEX)  * required Billing Address (for the specific card you are using for this transaction) Membership Dues Term (1-year or 2-year) One-Year $99 Two-Years $179
FPI Member Profile Information: Please include the following information so a complimentary FPI Business & Networking Profile can be created for you immediately.
	Business Name  * required Business Address & Phone Number (please include area code) Professional Designation (i.e Certified Fitness Trainer, Nationally Certified Strength Trainer, Physician, etc...)  * required Credentials (Certifying Organization such as ISSA, NASM, AMA, as well as any degree's or experience you wish to have listed) Specialties (please list your specialized practice or area of business to give a better idea of who you serve) Email Address  * required Web Address (please send email to centerforstrenth.com with you html banner code)
	I certify that I have full ownership rights any photos I have submitted for the FPI Directory Please Note:  You must fill out EVERY field in the order form for your order to be processed -including member information for renewals. 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 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.  Muscle Mind & More®, The Strength Doctor™, Project Infinite Endurance™ and N.Y. Strength™ Muscle Mastery Seminar™, and TopTrainer™, Precision Cuisine™  are Trademarks of Dr. Jack Barnathan, All Rights Reserved.