Desired Physique Registration Form

Registration Form

Enter your details below and I'll send you more details within 48 hours.
Which program are you interested in?*
Full Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Sex:
Phone Number*
Email
example@example.com
Full Name of Emergency Contact*
Phone Number of Emergency Contact*
Instagram Handle
Facebook Name
How did you hear about us?*
Do you have any existing medical issues? If yes, please explain.
I understand that participating in training with Desired Physique (online, personal, group or home) involves physical activity, which carries some risks. I confirm that I am healthy enough to take part or have consulted my doctor before starting. I accept that I am responsible for my own safety, and for any loss, damage, or injury that may occur as a result of my participation.*

I agree
Signature*
Date *

MonthDayYear
Date
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