VIP Group Application

Please fill out the form below to apply to my 2017 VIP Group. I will review and get back to you within the next 24 hours.

Name
First Last
Email
Mobile Phone
Facebook URL
In 2-3 sentences, tell me a little about yourself?*
Example: Family, Kids, Type of work you do, favorite hobby.
What are your current health & fitness goals?*
Be specific. The more I know the better I can help you.
What are you currently doing for excerise?*
In the past 30 days, can you tell me about your current eating habits?*
What is your biggest hurdle with fitness/nutrition or both?*
What is the one thing you wish to accomplish out of this group?*
What are the best day(s)/time(s) to reach you?