Applicant must be ACE and AFAA certified or have a degree in the fitness industry.

Please complete all information on this form. Waterworks staff is unable to add data to your application (e.g. biographies/course descriptions from previous brochures). If may be necessary for you to "cut and paste" information from other sources into this form.

First Name:        Last Name: 

Email:        Website: www.

Address: 

City:        State:        Zip: 

Home Phone:        Cell:        Work Phone: 

Degree (if applicable): 

Biography (60 words or less):


Workshop Title: 

Time Required:  (1.5-2 hrs. for workshop, 4-6 hrs. for pre-conference)

Description (50 words or less) for FitnessFest brochure: 

Learning Objectives:

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Target Audience:   Personal Trainers     Mind/Body Instructors      Coordinators/Managers
 Land Instructors     Aqua Instructors    Other

Participant Level:  Beginner     Intermediate     Advanced     All Levels

Workshop Format:  Select One Aqua Land Lecture Only

Percent Practical:       Percent Lecture: = 100%

Approval Numbers: ACE#:    AEA#:    AFAA#:

AV Equipment Required:  Overhead/Screen    LCD/Screen    Flip Chart    Dry Erase Board

Practical Equipment Required (i.e. yoga mats, barbells, etc.): 

Would you like a table for display/promotion purposes during this event?  Select One yes no

For multiple workshops, please return to this form. It is not necessary to fill out the personal information again.

NOTE: If biographies or course descriptions exceed the word limit, Waterworks will edit at its discretion.