Online Program Starter Form Fields marked with an * are required Last Name * First Name * Age * Email * Phone * City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Training Program Options * $200/month (4-wk workout & diet plan) $250/month (4-wk workout, diet plan, & weekly checkins) Pageant System (if applicable) Is there any reason you can't engage in physical activity? Yes No Do you have any type of injury/medical issue, orthopedic or otherwise? Yes No If so, please describe in detail. A doctor's release may be required for certain medical issues. Do you currently exercise? Yes No How long have you been currently exercising? Do you currently workout with weights? Yes No Describe a typical workout for weight training. Do you do cardio? Yes No Describe a typical cardio workout and how many days a week. Do you do group fitness classes? Yes No What types of classes? Are you a vegetarian? Yes No Do you have any known food allergies? Yes No If you have food allergies, please describe. Provide a typical daily food/drink diary. How long have you been eating this current diet? If you are a human seeing this field, please leave it empty.
