EMPWR 8 Week Challenge Sign Up Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: 0000-000-000.

Email

example@example.com

Challenge Round

Gender

Date of Birth

Date

Current Age

Please review the payment options available

MVP CURRENT MEMBER:

$399 Challenge Fee

- $100 Deposit Today

- $299 Before Challenge Starts (remaining balance must be paid prior to the start of the challenge)

- Continue your current membership

*If you are not a current member, you can still select this option and then will be required to sign up for our MVP Membership which is $51per week.

NOT A MEMBER:

$399 Challenge Fee

- $100 Deposit Today

- $299 Before Challenge Starts (remaining balance must be paid prior to the start of the challenge)

- $65pw Direct Debit for 8 weeks with first debit starting on Day 1 of the challenge

*With the option to continue post-challenge on our MVP membership or
become a member now and pay member price.

WEEKLY PAYMENT OPTION:

- $100 Deposit Today

- No further payments required before the challenge starts

- $99pw Direct Debit for 8 weeks

*With the option to continue post-challenge on our MVP
membership

**The "Weekly Payment Option" is for participants who don't hold an active membership or for participants with an active membership who wish to go on the "Weekly Payment Option" which therefore your current active membership will be paused during the challenge.

Payment Option

You have the option to purchase two different merch packs at a discounted price in addition to the challenge cost.

Please note these discounts are exclusively available at the time of sign-up. Once the deposit has been paid, this offer will no longer be available. The EMPWR Unisex Challenge Singlet/Shirt is a limited item and will not be available for purchase over the counter.

Option 1: MVP Pack - RRP $115.50 your price $89

- EMPWR Unisex Singlet/Shirt

- EMPWR Unisex Socks

- EMPWR Shaker

- EMPWR Towel

- EMPWR Tote Bag

Option 2: Swag Pack - RRP $70 your price $55

- EMPWR Unisex Singlet/Shirt

- EMPWR Unisex Socks

Would you like to purchase a merch pack? Payment for packs will be required before the start date of the challenge

If you selected a merch pack would you rather a T-Shirt or Singlet (unisex)

T-Shirt/Singlet Size (unisex)

If you selected a merch pack please choose your socks colour/size

Emergency Contact Name

First NameLast Name

Emergency Phone Number

Please enter a valid phone number.Format: 0000-000-000.

What is your Challenge Goal?

Important Note

Achieving both muscle gain and fat loss at the same time is possible, particularly if you're new to training, returning after a break, or have higher body fat levels. However, it is significantly more difficult to maximise both goals simultaneously, especially within an 8-week challenge.

If you choose Build Muscle, the primary focus will be on increasing muscle mass, with body fat changes being a secondary outcome.

If you choose Drop Body Fat, the primary focus will be on reducing body fat while preserving as much muscle as possible.

For the best results, we recommend selecting one clear primary goal for the challenge. This allows us to tailor your nutrition and training to maximise your progress over the 8 weeks.

On average, how many times a week during the first 4 weeks of the challenge do you plan on training?

Do any of the following apply to you? (Other dietary requirements/intolerances can be listed further below in this form)

Are there any foods you dislike or will not eat ?

There's no need to list every individual food item, just let me know any major foods, food groups, cuisines, or ingredients you generally avoid or don't enjoy.

Are there any foods you dislike or will not eat ?

Please tick if any of the following applies to you?

If you ticked any of the above please explain?

Please tick if any of the following applies to you?

If you ticked any of the above please explain?

Are you a smoker ?

What is your average sleep (hours per night)?

What is your current occupation?

Select Your CURRENT Weekly Activity Level?

Select Your Unplanned (Non-Exercising) Activity Level

Do you drink more than 10 standard drinks of alcohol per week?

Do you eat at least 1 serve of fruit and 3 serves of vegetables a day?

Your name on Facebook?

(This is so we can add you to the private challenger facebook forum)

JS & BC Pty Ltd (“EMPWR”) accepts no responsibility for, and you release EMPWR from any claim relating to, personal injury or loss of life incurred or suffered as a result of a program of physical exercise (“Program”). In the event that you attend a program of physical exercise (“Program”) with a minor, the minor in attendance (“Minor”) must be supervised. JS & BC Pty Ltd accepts no responsibility for the supervision of Minors. EMPWR further disclaims any liability for, and you release EMPWR from any claim relating to, personal injury or loss of life incurred or suffered by Minors. All denials of responsibility by EMPWR, and releases and indemnities provided by you under this agreement, only apply to the extent that they do not exclude, restrict or modify, or have the effect of excluding, restricting or modifying: the application of all or any of the provisions of Part 3-2, Division 1 of the Schedule 2 of the Competition and Consumer Act 2010 (Cth) (“the Act”); or the exercise of a right conferred by such a provision; orany liability of a person for a failure to comply with a guarantee that applies under the Act to a supply of goods or services.

Injury
I understand that if I am injured in the duration of the 8-week program and no longer able to train, that I am still able to commit to the nutrition and seminars that the program has to offer. I understand that I must provide a medical certificate from a health professional stating that I cannot train for the rest of the duration of the challenge. Once EMPWR has received your certificate, you will be credited for the remaining of the training that you will miss. This will be credited in way of a training certificate which cannot be transferred or refunded in way of monies. At no point once the challenge has commenced will you be refunded any monies from your participating challenge.

Pregnancy
I understand that if I fall pregnant in the duration of the 8-week program, I will no longer be able to receive dietary advice from EMPWR. I am still able to commit to the seminars and training that the program has to offer. I understand that I must provide a medical certificate from a health professional stating that I can still train for the rest of the duration of the challenge. Once EMPWR has received your certificate, you will be credited for the eating plan that you will miss at the value of $100. I must provide a medical certificate from a health professional stating that I cannot train for the rest of the duration of the challenge. This will be credited in way of a training certificate, which cannot be transferred or refunded in way of monies. At no point once the challenge has commenced will you be refunded any monies from your participating challenge.

By submitting this form, you acknowledge that you have read and agree with the T&C’s. To view the T&C'c click the link below

I agree to pay for the services provided under this Agreement in the amount and using the method described in:

Signature

My Products

Challenge Deposit

This $100 deposit is required to secure your spot in the EMPWR Training Hub 8-Week Program. The deposit will come off your total 8-Week Program price. Please note there is a $2.99 transaction fee for deposits paid online (therefore total debit of $102.99 will be made).It is important to note that the deposit is non-refundable, non-transferable and non-exchangeable.

$102.99 AUD

Pay Deposit and Remaining Ballance

This payment includes a $100 non-refundable deposit to secure your place in the EMPWR Training Hub 8-Week Challenge, along with the remaining balance of $299, meaning your challenge is paid in full.

Once this payment has been processed, there is nothing further to pay unless you choose to purchase an optional merchandise pack.

Please note there is a $2.99 online transaction fee, bringing the total payment to $401.99. The deposit payment of $100 is non-refundable, non-transferable, and non-exchangeable.

$401.99 AUD

Total

8 Week Challenge!

Nutrition

Training

My Products