ITCA
Triathlon Coach Certification Order Form
Registration is available January 5, 2009
Please
read the Policies
& Procedures prior to ordering
No personal checks are accepted. We will accept company
checks, money orders and bank checks.
Note: If you have already ordered "secure online,"
this form is not needed.
Follow the instructions on the form and mail or fax
to the address listed below.
Please
print clearly or type:
First Name:
__________________________ MI: __________________________
Last Name: __________________________ Company/Organization:
__________________________
Name
as you would like it to appear on your certificate(s),
if you are ordering a certification program:
_____________________________________________________
Mailing Address: __________________________ City __________________________
State/Province: __________________________ Zip/postal
code: __________________________
Country: __________________________
Daytime telephone: (______) ____________________ Fax
number, if available: (______) ____________________
E-mail Address: __________________________@____________________________________________________
How did you find us on the Internet? (Yahoo, Exite,
Info Seek, Web Crawler, etc.)
What was your search word(s)? __________________________
Credit card, Debit Card, Bank Check, Money Order,
U.S. funds only
Account Number: __________________________
Expiration Date: ______/____________
CVC Code*: ___________
Name on Card: __________________________
Signature ____________________________________________________
*Visa
and Mastercard
In the signature box on the back of your Visa you
should see a 16-digit credit card number followed
by a special 3 digit code.
This 3 digit code is your CVC.
American
Express
On the front of your card next to your main credit
card number look for a 4 digit code. This 4 digit
number is the Card Security Code.
For
fast processing, mail to:
NESTA Triathlon Coach CertificationOrder
30245 Tomas
Rancho Santa Margarita, CA 92688 USA
Make
business check or money order payable to:
NESTA
For
the fastest service, pay by credit card and fax your
application to: (949) 589-8216
If
you have any further questions, please call toll FREE
1-877-348-6692
NESTA
- National Exercise & Sports Trainers Association
