Join Light Life at Cuong Strong
Date
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Month
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Day
Year
Name
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Age
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Email
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Phone Number
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Address
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Street Address
Street Address Line 2
City
State
Zip Code
What is your goal?
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What is holding you back from reaching your goal?
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What inspired you to contact Cuong Strong?
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Do you have any of the following conditions? If so, please explain
Heat or light sensativity
Recent burns
Malignant cancers
Hyperthyroidism
Pregnant
Eye disease
Systemic lupus erythematosus (SLE)
Fever or infection
Severe bleeding or blood loss
Other
Please explain any conditions related to your health
List all medications and/or supplements
Which plan are you most interested in?
1 on 1 Personal training & nutrition (1 session per week or 5 per month) ($270 for the first month then $235 for the next month)
1 on 1 Personal training & nutrition (2 sessions per week or 10 per month) ($490 for the first month then $440 for the next month)
Exclusive gym membership ($70 for the first month then $50/month w/ training plan)
Online training & nutrition ($270 for the first month then $235/month)
Meal coaching ($170 for the first month then $120/month)
Contest Prep ($290 for the first month then $255/month)
Red light therapy ($80-120/month)
How did you hear about Cuong Strong?
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By submitting this form I agree, I have read, understand, and answered all the above questions fully and truthfully
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