Registration For Mediterra’s Live Run Training Events Run Event Registration Step 1 of 3 33% Participant InformationName Of Participant* First Last Email* Have you made a registration and payment for this event already?*YesNoYou don't have to fill in the rest of your personal information if you have already filled out a registration for this event previously, and you will just pay the remaining amount. Gender*FemaleMaleYour age at the time of training event...*Phone*Please include the country code.Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Your Training EventChoose the event type...*Private TrainingGroup TrainingSelect your private training type...*Single Lesson 60 minutesSingle Lesson 90 minutesLesson SeriesEnter your private training payment amount...* The non-refundable deposit is $60. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance. Select your group training event...*Run Better 4-Lesson Series January 2019Run Better 4-Lesson Series in March 2019Which group lesson time will you join?*Monday mornings, 9:00amTuesday mornings, 5:30amWhich category of participation?*Courthouse Fitness MemberNot a member of CourthouseCourthouse Fitness Staff MemberNo worries - you do not need to be a member to participate, and there are no additional fees to come into the club for our live sessions. Enter your group training payment amount...* The non-refundable deposit for each swimmer is $20. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance.Total Payment $0.00 PaymentTotal payment you intend to make... $0.00 If this is not correct, you may go back and edit the payment amount on the previous page. Please read our Privacy Policy. By filling out this registration form, you agree to trust us with very limited use of your personal your data to provide coaching services to you. We do NOT share your information with anyone outside our administrators. You also agree to be added to a mailing list that enables us to send you information about this particular training event and Mediterra's services in general. You are welcome to unsubscribe from the list at any time by following the link at the bottom of each email. Please read our Terms and Conditions and our statement of Responsibilities, Waiver and Release.Do you agree to the terms of these three documents?*YesNoBy submitting this registration you will be agreeing to the terms in these three documents, for yourself or on the behalf of the one you are registering for this event. It appears that you will not be able to complete the registration at this time. If you have concerns or questions regarding our terms for participation, we would be glad to have you contact us to discuss it. Select form of payment...*I will pay with my CREDIT CARD.I will pay with my PAYPAL account.I have made other payment arrangements with the Mediterra OfficeEnter your credit card information...* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name .Click to email this to a friend (Opens in new window)Click to print (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Like this:Like Loading...
