Application FOrm

1
What's your Full Name?* This field is required.
First Name
Last Name
2
What's your Email Address?* This field is required.
example@example.com
3
What's your Mobile Number?* This field is required.
Please enter a valid phone number.
4
How much money have you spent trying to achieve your goals?* This field is required.
5
How does that make you feel?* This field is required.
6
Why do you think you're not at your desired goal right now?* This field is required.
7
How do you feel about your body right now?* This field is required.
I don't want to look at myself
I don't think I look great
I could look better
I think I look okay
I look good
I would walk down the street naked!
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I don't want to look at myself
I don't think I look great
I could look better
I think I look okay
I look good
I would walk down the street naked!
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8
What are your energy levels like right now?* This field is required.
I can barely get out of bed!
I'm a little tired
Pretty standard
I feel pretty good
Never felt better!
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I can barely get out of bed!
I'm a little tired
Pretty standard
I feel pretty good
Never felt better!
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9
Please answer honestly - do you?* This field is required.Choose all the apply!
Smoke and/or vape?
Drink alcohol?
Eat takeaways?
Eat other junk food?
None of the above
10
What's your profession?* This field is required.
11
What made you fill in this form today? Please be as detailed as possible* This field is required. Example: Had enough, seen no results, lack of progress etc.
12
What have you tried in the past? What worked? What didn't work?* This field is required.
13
Which describes you best?* This field is required.
Excuse maker that's always looking for a magic pill
Procrastinator that always puts things off
An action taker that wants to make changes NOW
14
What are you looking for from a 90 Day Transformation Program?* This field is required.Choose as many as apply
Life-changing results that are sustainable
Support and guidance from a like-minded group
Motivation and daily tasks to stay on track
A coach/mentor to keep me accountable 24/7
ALL OF THE ABOVE!
15
I seek to give a transformational opportunity to those that are ready to take it on. If this is the case when we speak, are you ready and willing to financially invest?* This field is required.
YES - I'm ready and willing to financially invest in my health, fitness and body!NO - I'm not ready and willing to financially invest in order to change my current situation.
16
Is your Partner fully supportive and aware of your current situation regarding your Health & Fitness Goals?* This field is required.
Yes, he would want me to invest in my health and myself in order to get the results I deserve.No, it's something we would have to discuss.
17
Finally, we're very selective about whom we let into our Wedding Weight Loss program - why should we choose you?* This field is required.
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