Conference Advertising Application Form

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

Company Name: *
Contact Person: *
Contact Number: *
Email: *
Web Address: *
Address: *
City: *
State
Province:
Zip/Postal Code:
Country *
Advertisement Type: *
Advertisement Dollar Amount: *
If providing a tote bag insert, please describe the type of insert you wish to provide (collateral, pamphlet, tangible item). All inserts must be approved by the PMA prior to insertion.
(Maximum characters: 2000)
You have characters left.

Payment Information:

Choose method of payment:

Payment by Credit Card:
You can submit your credit card information one of the three following ways:
1. Download the credit card authorization form provided below, complete and re-upload prior to submitting the application.
2. Fax to 305-573-4461, attention Maly De Jesus
3. Email directly to Maly De Jesus at maly@pilatesmethodalliance.org

Please note applications submitted without payment information will not be processed until payment info is received.

Payment by Check:
Only checks drawn on US banks are accepted and must be made out to: Pilates Method Alliance.
Please send check to PMA, 1666 Kennedy Causeway, Suite 402, North Bay Village, FL 33141.

PLEASE CLICK HERE TO DOWNLOAD CREDIT CARD AUTHORIZATION FORM

Please upload your completed credit card authorization form here.
I authorize the Pilates Method Alliance to process my payment (check or credit card). I understand this constitutes a legally binding agreement. I further certify that the application information above is true and complete, and that I am authorized to sign on behalf of the above listed company. I understand that falsification of any of the information may result in the revocation of listing. *

Clear Selection
Signature: *



Your form submission WILL be encrypted using SSL to ensure your privacy.

        
© 2003-2013 All Rights Reserved.
 
Popular Links
 
Become a Member
 
Renew Membership
 
Membership Benefits
 
Liability Insurance
 
Learn about Certification 
 
Renew your Certification
 
Continuing Education
 
Teacher Training Summit
 
PMA Conference
 
 
 

Sustaining Sponsors:

      

   



   Media Sponsor: