Teleclass Form
(print out and fax to Aim For It Fitness 218-846-0811)

Name ___________________________________________________

Phone _____________________________

Address____________________________________________________

Email ___________________________

Indicate Time
12:10 pm (CST) _____ 1:10 pm (EST) _____ 7:00 pm (CST) _____ 8:00 pm (EST) _____

Please charge my ____ MasterCard ____ Visa ____ Other (fill out below)

Card number __________________________________ Expiration date __________

Today’s date ___________

Address on file with credit card company (if different from above), including zip code_______________________________________________________

Signature ___________________________