The Longevity Project Participant Application

THE LONGEVITY PROJECT APPLICATION
BASIC INFORMATION
Thank you for your interest in the Longevity Project.

This 90-Day Strength & Longevity Experience is designed specifically for women 40+ who want to build strength, protect bone density, and improve metabolic health through structured training and sustainable nutrition practices.

Because this cohort is limited to 10 women, completing this questionnaire helps determine program fit and ensures participants are prepared for the commitment.

Once your form is reviewed, you will receive confirmation regarding whether or not you have been accepted to participate in the Longevity Project.

Program Investment: 12,000PHP for the 90-day experience.
A limited referral rate may apply for certain community recommendations.
Name*

First NameLast Name
Age*
City / Country*
Email*
example@example.com
Phone Number/ WhatsApp Number*
Please enter a valid phone number.Format: (000) 000-0000.
HEALTH & FITNESS BACKGROUND
Sedentary (little to no exercise)Light activity (walking, occasional workouts)Moderate activity (2–3 workouts per week)Active (4+ workouts per week)
Yes, regularlyOccasionallyNo, but I want to startNo experience
Gym membershipHome gym with free weightsLimited equipment at homeNot yet, but I will arrange access to a gymNot yet, but I will purchase free weights
Do you have any injuries, limitations, or medical considerations that may affect training? If yes, please list or elaborate.*
LIFESTYLE
Less than 5 hours5–6 hours6–7 hours7–8 hours8+ hours
LowModerateHighVery High
Mostly whole foodsBalanced but inconsistentOften eat on the goFrequently rely on processed foods
MOTIVATION
Why are you interested in joining the Longevity Project?*
What do you hope to gain over the next 90 days?*
Empowered's social mediaEmpowered websiteA friend or participant referralNew Life Church communityReferred by Pastor HeidiLocal community FB pageOther
COMMITMENT
I understand this is a 90-day structured program.I understand weekly online check-ins and online participation are expected.I understand the Longevity Project focuses on strength, longevity, and sustainable health — not rapid weight loss.I confirm that I will maintain access to a gym or weight training equipment.
Signature*

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FINAL MESSAGE
Thank you for completing the Longevity Project Application. After your application has been reviewed, you will be notified if a spot is available and will receive the next steps for securing your place in the program.

-- Coach Amy
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THE LONGEVITY PROJECT APPLICATION

BASIC INFORMATION

HEALTH & FITNESS BACKGROUND

LIFESTYLE

MOTIVATION

COMMITMENT

FINAL MESSAGE