Gym Registration Form

please fill out this form with the required information

Name Email Age (optional)

How often are you willing to train a week to reach your goal?

Are you experiencing any stresses or motivational problems?

Yes

Sometimes

Your current diet could be best characterized as:

low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet

Whats the activity level at your job?

none(seated only)
Moderate(light activity such as walking)
High(heavy labor/very active)

Your feedback is important!