2010 Program starting dates

 Next program start date:   6th September

Body Transformation Program Entry Form

Congratulations on taking the first step to getting started on your own Body Transformation Program.  The details you provide in this Personal Profile will be used to create your unique Transformation Package and Nutrition Plan.

The Body Transformation Program begins in the first week of next month. To obtain your training and nutrition package and confirm your place in the program, you must submit this Personal Profile before the end of this month! 

NB: The Body Transformation Program may not be appropriate for people with specific conditions; we will alert you if this applies to you.

First Name:
  *
Surname:
  *
Address:
  *
Phone:
  *
Mobile:
  *
Email:
  *
DOB:
  *
Gender:
Male
Female
  *
Occupation:
  *
Please tick if any of the following apply to you:
Age < 18 Years
Age > 65 Years
Pregnant
Breastfeeding
Cancer
Type1 Diabetes
Type 2 Diabetes
Impaired Glucose Tolerance
Taking Insulin
Hypothyroid
Heart disease
High blood pressure
High Cholesterol
Gout
Liver disorder
Kidney disorder
Eating disorder
Are you taking any medication which may effect your ability to exercise (Please list all):
Any other medical conditions or injuries that may effect your ability to exercise?:
My current weight is (kg):
  *
My overall goal is:
  *
Please tick:
Weight-loss & toning
Muscle gain (bulking)
  *
How regularly do you exercise each week:
  *
Give an example of your regular activities (e.g. Gym, walking, swimming etc):
  *
How active are you during your working hours and leisure?:
  *
How regularly do you eat junk food and takeaway per week?:
  *
Which is your healthiest meal of the day:
  *
What are your time preferences for your weekly personal training sessions? (please provide a few options):
  *
Do you have a preference , male or female trainer?:
  *
Select your trainer preference?:
Silver Trainer: Under 3 years experience $74.95 p/w
Gold Trainer: Over 3 years experience $84.95 p/w
Platinum Trainer: Extensive indutry experience and knowledge $94.95 p/w
Which centre will you be taking part in the program?:
Northside Fitness Centre, Dickson
Club Lime Belconnen
Club Pink Belconnen
Send me a copy
* Required field
New Development by InterJoomla