Name: *

Best phone number to reach you: *

Email: *

Age: *

What is your Instagram @?: *

What is your occupation?: *

What is your number one struggle currently?: *

How long have you been struggling with this?: *

How would you describe your current exercise routine?: *

I don՚t have a routineI exercise sometimes but lack consistencyI have a solid exercise routine

What are your main fitness and lifestyle goals? (check all that apply): *

Increase personal discipline through added structure to my lifeCreate an unstoppable mindset to gain control of my lifeCreate a more healthy lifestyleGet in shape: lose weight/ build lean muscle/ cut fat/ etc.

Describle your long term goals (next 6-12 months): *

Are you ready to invest the time, effort, and resources into yourself to reach your goals?: *

YesI understand the value of this investment!I՚m not sure. I need to think about itNot right now

On a scale of 1-10, how determined are you to reach your goals? : *

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If your application is accepted, how soon can you start? : *

Right awayWithin a weekWithin a month

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