AntiGravity® Affiliate License Request
This form is meant for the club owner to complete when applying to become a license ANTIGRAVITY® Affiliated Studio.

Please complete the information below so that we may create your AntiGravity® Affiliate License document which will then be emailed to you for completion.
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Email *
STUDIO INFORMATION
Name of Studio *
Company Name (legal entity) *
Full Contact Name *
This should be the owner or responsible signatory
Studio Address *
Must include: Address Street, City, County, Postal Code, Country and will be listed on the AntiGravity Website
Studio Phone Number *
This will be listed on the AntiGravity Website
Studio Email *
This will be listed on the AntiGravity Website
Latitude *
Please use http://www.latlong.net This allows us to pin point your location and list on the AntiGravity Studio Finder Map
Longitude *
Please use http://www.latlong.net This allows us to pin point your location and list on the AntiGravity Studio Map Finder
LICENSE INFORMATION
License Requested *
Required
License Start Date *
MM
/
DD
/
YYYY
Please list the name/names and CAGI numbers of each AntiGravity® Instructor who will be teaching at your studio.
Year 1 License Fee (to be completed by Athleticum)
Yearly Renewal Fee (to be completed by Athleticum)
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