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*Money Back Guarantee* - Weight Loss Program
Please fill out this form for your chance to achieve your ULTIMATE RESULTS...
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FIRST 20 PEOPLE RECEIVE FREE 30 DAY TRIAL & FREE NUTRITIONAL CONSULTATION ($150 VALUE) @ Durham Ultimate Fitness Club
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
E-mail Address
*
Your answer
Club location of interest?
*
Bowmanville
North Oshawa
Oshawa
How much weight do you want to lose?
*
Your answer
How serious on a scale of 1-10 are you? (10 being most serious)
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Not Serious
1
2
3
4
5
6
7
8
9
10
Most Serious
How long have you been trying to lose the weight?
*
Your answer
Have you participated in any other weight loss programs?
*
Yes
No
If you answered YES - Please give a brief summary of the program and your results.
Your answer
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