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First Name

Email Address

Last Name

Phone

Do you currently engage in regular activity?

No, not at all

1-2x a week

2-3x a week

3-4x a week

If yes, what kind?

Do you have any health challenges that may interfere with exercise (ie. injuries, arthritis, pain, etc.)? *

No

Yes

Have you ever heard had any surgery, broken bones, or physical limitations? If yes, please explain.

What are you health & fitness goal(s)?

2. SCHEDULE TIME!

3. SHOW UP!

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