Be The Coffee - 35 Day Challenge

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Area Code
Phone Number
4
What time do you wake up every day?* This field is required.
5
How Many Times do you Consistently Workout per Week* This field is required.
0
1
2
3
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5
6
7
8+
6
Are you interested in losing fat?* This field is required.
YESNO
7
Are you interested in gaining muscle?* This field is required.
YESNO
8
What's the most important part of this challenge for you?* This field is required.
Physical
Mental
Accountability
Momentum for 2021
9
Tell me a little bit about your goals for this challenge* This field is required.
Huge
Large
Normal
Small
Ok
Ok
10
One a scale of 1 to 10, 10 being the highest, how committed are you to completing this challenge?* This field is required.
1
2
3
4
5
6
7
8
9
10
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Ok, Why didn't you pick a lower number?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
12
Let's try again. One a scale of 1 to 10, 10 being the highest, how committed are you to completing this challenge?* This field is required.
1
2
3
4
5
6
7
8
9
10
13
Be The Coffee 35 Day New You Challenge* This field is required.
prevnext( X )
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
2022 35 Day Challenge
$297.00+Edit
Back
Enter Coupon
Total cost $0.00
Credit Card
First Name
Last Name
14
I Acknowledge and Agree to the following: * This field is required.All Information is kept confidential by Dragon Gym and its employees. I am aware martial arts and fitness training can be a hazardous activity and I am voluntarily participating in these activities with the knowledge of the danger involved, including personal injury, sickness or death. I hereby unconditionally release Dragon Gym,Dragon Gym Legacy Inc., its servants and/or employees from any and all liability for any claims, demands, injuries, damages, actions, or causes of action whatsoever, which are or may be sustained by, to or for myself, family members or my property arising out of control of or connected with the use of any services or facilities of Dragon Gym or Dragon Gym Legacy Inc. I am in good health and/or have had medical approval to engage in any martial arts or fitness training programs. I assume all risks that are apart of and incidental to the Dragon Gym and I have read, understand and will comply with the above rules and regulations of the Dragon Gym.
YESNO
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