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New Year, New You Registration
Please fill out this form, be sure we are Facebook friends at
https://www.facebook.com/jackie.d.kent
and I will get back with you ASAP.
* Indicates required question
Email
*
Your email
First Name, Last Name
*
Your answer
Are you currently working with a Beachbody Coach?
*
Yes
No
If yes above, Coach's name
Your answer
What are you doing now for fitness?i
*
(Check all that apply)
Workout DVDs
Exercise Outdoors
Gym membership
Don't workout but I want to
Other:
Required
What are your health and fitness goals?
*
(Check all that apply)
Lose 5-10 lbs
Lose 10+ lbs
Tone up
Gain muscle
Learn to cook and eat healthier
Maintain what I'm currently doing
Other:
Required
Any physical limitations?
*
Yes
No
If yes above, please explain
Your answer
When are you ready to begin?
*
Immediately
In a few weeks
In about a month
Anything else we should know?
Your answer
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