KUKUWA®, LLC.

1172 S. Dixie Hwy. Suite 154, Coral Gables, FL 33146
Phone: 1-866-9KUKUWA (958-5892) • Fax: (571) 312-8621
E-mail: info@kukuwafitness.com • Website: www.kukuwafitness.com

CERTIFICATION RENEWAL APPLICATION AND MEMBERSHIP FEES

To renew your certification, please fill out this form.

* Submit copies of your CEC credit forms (20 credits required) THIS IS WAIVED FOR NOW
* Submit proof of current CPR.
* Include your membership fee listed below.

Date(required)

Your Name (required)

Your Address (required)

Your Email (required)

Certification Exp. Date (required)

Phone Number (required)

Membership Renewal Fees:

**You must constantly maintain an active $9 per month Certified Instructor Membership. This is your only renewal fee.**

CEC credit forms

Upload CEC credit forms

CPR Certification Organization (required)

Expiration Date(required)

(Copy of your current CPR certification, front and back required).

Upload CPR certification - front

Upload CPR certification - back

I certify that the above information is complete, accurate and proof of completion of the above listed items requested. Your renewal will be revoked if any of the above information is false and incomplete, and no refund will be issued. Membership fees are required to renew your certification.