Registration Form

Price:

Rs20,000 for 1 Month

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1: Address Line 1 is not valid

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City: City is not valid

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Phone Number: Phone Number is not valid

Date of Birth:* Date of Birth is Required

Gender: Gender is not valid

What’s the activity level of your job: What’s the activity level of your job is not valid

How would you describe your working hours regular, shift or roster. Please mention times: How would you describe your working hours regular, shift or roster. Please mention times is not valid

Please list the physical activities that you participate outside of the gym and outside of work: Please list the physical activities that you participate outside of the gym and outside of work is not valid

Do you ever feel faintish or have spells of dizziness during physical activity/exercise that causes you to lose balance: Do you ever feel faintish or have spells of dizziness during physical activity/exercise that causes you to lose balance is not valid

Yes No

Do you suffer from any of the conditions that required immediate medical assistance at any point over the last 12 months if yes please list: Do you suffer from any of the conditions that required immediate medical assistance at any point over the last 12 months if yes please list is not valid

Yes No

if yes please list: if yes please list is not valid

Asthma attacks Heart conditions or stroke Diabetes High or low blood pressure

Have you been diagnosed with any muscle, bone or joint problems that you have been told that could Aggravate by participating in physical exercise: Have you been diagnosed with any muscle, bone or joint problems that you have been told that could Aggravate by participating in physical exercise is not valid

Yes No

Are you experiencing any stresses or motivational problems: Are you experiencing any stresses or motivational problems is not valid

Yes No

Has anyone of your immediate family developed any of the conditions mentioned below: Has anyone of your immediate family developed any of the conditions mentioned below is not valid

Yes No

If yes please select: If yes please select is not valid

Asthma attacks Heart conditions or stroke Diabetes High or low blood pressure

Do you smoke/drink Yes / No If Yes how often: Do you smoke/drink Yes / No If Yes how often is not valid

No Daily Regularly Occasionally

If you are on any other medications for any reason please mention here: If you are on any other medications for any reason please mention here is not valid

What following goals does best fit in with your goals: What following goals does best fit in with your goals is not valid

Improve Health Improve Endurance Increase Strength Increase muscle mass Fat Loss

Timeline to achieve your goal: Timeline to achieve your goal is not valid

1 Month 3 Month 6 Month 9 Month 12 Month

How often are you willing to train a week to reach your goal: How often are you willing to train a week to reach your goal is not valid

3 times a week 4 times a week 5 times a week 6 times a week

Are you currently exercising regularly (at least 3x per week): Are you currently exercising regularly (at least 3x per week) is not valid

Yes No

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Password Strength Password must be “Medium” or stronger

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Description	Amount
One Month Individual – Initial Payment	Rs20,000.00
Total	Rs20,000.00

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