Evaluation Booking Sheet

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To book your evaluation (new or renewal), submit this form to the MFC office at least 2 weeks before your preferred date.

*For those who are renewing an accreditation, please note that if you are accredited in more than one specialty, only one evaluation is required every three years, alternating between each specialty modules.

Once the MFC receives this form, we will contact evaluators to fill your request. Once an evaluator agrees to do your evaluation, he or she will contact you directly to confirm the details.

The MFC will issue you an official receipt for your evaluation payment and will also pay the evaluator (to keep the evaluator fees consistent). The MFC also pays evaluator mileage where applicable.

Name *

Address *

Phone *

Email Address *

Evaluation Type *

New ($100.00)

Renewal ($110.00)

New Combined ( Two certifications at once) ($85.00)

Specialty (Choose all that apply) *

Circuit Training

Group Cycling

Group Fitness Choreography and Step

Pilates

Resistance Training

Registered Personal Trainer

Yoga

Aquatic Exercise

Tai Chi

Active Older Adult

How do you plan to do your evaluation? *

In Person

I will record it and send it in

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