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First Name |
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Last Name |
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Email |
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Street Address |
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City |
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State |
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ZIP Code |
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Cell Phone
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Alternate Phone |
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Gender |
Male |
Female |
Year You Were Born: |
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Marital Status |
Single |
Divorced |
Widowed |
Other |
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Annual Income |
25,000-50,000 |
50,000-75,000 |
75,000-100,000 |
100,000+ |
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Employer
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Title / Position
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Are you a current or former client of SWAT? |
yes
no |
How did you hear about us? |
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Current fitness level, on a scale of 1-10
(with 1 being poor and 10 being excellent) |
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Details about your fitness history and current condition: |
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My primary goal for this program is to: |
Lose Weight |
Tone Up |
Have Some Fun |
Meet the Love of My Life |
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If the Singles Camp fills up or isn't a good fit for you this time around, would you be interested in participating in a second
boot camp (on same days at same times) if not designated a "Singles Only" camp?
Yes
No |
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Why I Want to Participate in Boot Camp: |
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If I Qualify,
I agree to pay
the $100 registration fee.
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Send me an invoice via paypal
I will send a check
Call me and I will pay by phone |
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By submitting this form, you agree to pay the registration fee of $100 if you qualify and are chosen to participate. You understand that participants are chosen
at the sole discretion of SWAT Personal Training and there are no guarantees that you will be eligible. Participants must sign a detailed health questionnaire and liability waiver, and may be asked to seek clearance from a Medical Doctor. You agree that you are in good health, and do not suffer from any serious medical condition and are not currently under medical care.
Initials
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I understand that if I am chosen to participate, I am committing to being present for all 4 Saturday sessions of the Boot Camp. I understand that my participation and involvement is an important part of the success of the program. If I am chosen, I will commit to the expectations of the program and put forth my best effort.
initials
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