Contact Information
Contact Name:
Position
Organization:
Street Address:
City, State, Zip:
E-Mail:
Daytime Phone:
Fax Number:
(
Required
)
Courses
What course(s) are you interested in?
2 Day Instructor Lead - Includes Manual
Primer, Online Course (Day 1 of Blended Course) - Includes materials
Fusion (Day 2 of Blended Course) - Includes Manual
Courses
What product(s) are you interested in?
Swimmers: Courage and Triumph $24.95
Certified Pool Instructors Training Program $150
Pool Math Workbook $19.95 (Included in training program)
CPO Handbook (English) $59.95 (Included in training program)
CPO Handbook (Spanish) $59.95
Payment Method
Check made payable to Safe Aquatics (EIN 38-3231170)
Signed Purchase Order #
Send invoice to above address
Visa or Mastercard
Account Number:
Experation Date:
Month
/
Year
Name on Card:
Billing Address
of Cardholder:
Same As Above
Street Address
City, State, Zip
Comments
Additional Comments
