Thank you for choosing the Pilates Institute of Maryland for your Pilates Training, Information and Certification. 

This form will be used to register for the Pilates Instructor Certification

and the Pilates, Joseph, H. Workshop only. 

To register for the Pilates Instructor Certification or Pilates, Joseph, H. Workshop, please complete and sign the form below. 

Name:  _____________________________________________________

Address:  ___________________________________________________

Phone number:  ____________________(home) __________________(work or cell)

Email:  ___________________________

Emergency contact:  _____________________________ Relationship:  __________

Location and date of the certification or workshop you have choosen to attend:  ___________________________________________________________________________

Participation Waiver

I acknowledge that there are certain dangers inherent in any physical fitness activity including participation in a Pilates Certification or Workshop.  I hereby for myself, my heirs and my assigns, waive any and all claims to damages I may have against Jo-Ann Giles, the Pilates Institute of Maryland (PIM), its officers, employees, Darryl Giles, the facility at which the workshops are held, any agent or representative of any of the preceding for any and all injuries suffered by me while traveling to, from and participating in this event. The Pilates Institute of Maryland and Jo-Ann Giles recommends that all participants seek individual consultation with a physician of their choice before engaging in any physical fitness activity, including the Pilates Institute of Maryland's Pilates Instructor Certification and any other workshops by the Pilates Institute of Maryland and/or Jo-Ann Giles.  To the best of its knowledge, the Pilates Institute of Maryland and Jo-Ann Giles' knowledge, the information and techniques to be presented at the Pilates Instructor Certification and any other workshops by PIM, are accurate.  However, the Pilates Institute of Maryland and Jo-Ann Giles disclaims any responsibility for the individual use or application of such information or techniques by the participant. Due to weather, presenter illness, travel mishaps or any other situation out of the Pilates Institute of Maryland or Jo-Ann Giles control, the Pilates Institute of Maryland and Jo-Ann Giles reserves the right to reschedule any certification or workshop.  I understand that I may be videotaped, audio recorded and photographed during the event and the Pilates Institute of Maryland and Jo-Ann Giles may use the image for any and all uses.All payments are non refundable unless the event is cancel by PIM or natural disaster. Having signed below where indicated, participant acknowledges and agrees to the foregoing.

Signature:  ______________________________________  Date:  _____________________

Please return this form with payment (check or money order please) to:

Pilates Institute of Maryland

PO Box 44702, Fort Washington, Maryland 20749-0702

Questions?  JoAnnGiles@verizon.net or call 301 257 4819

Thanks again :-)