PERSONAL INFORMATION
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First Name:
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Last Name:
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Address:
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City/Town:
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State:
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Zip Code:
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Phone:
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Fax:
Date of Birth (mm/dd/yy):
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Gender:
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Female
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E-mail Address:
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Personal Website or Blog:
Occupation:
Do you have a valid passport?
Yes
No
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LIFESTYLE
Height:
ft.
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in.
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Present Weight (lbs.):
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Former Ideal Weight (lbs.):
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Age at Which You Achieved Your Former Ideal Weight:
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Have You Ever Competed in a Fitness Competition?:
Yes
No
If So, What Year?
Why Do You Want to Get in the Best Shape of Your Life?
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Will work, school or other activities/duties in any way interfere with your ability to complete the exercise portion of your transformation (i.e. 1.5 hours/day of cardio and weight training 4 times a week for 30 minutes)?
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Yes
No
What is the longest period of time you have been on a diet in the past?
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less than a month
1 - 3 months
3 - 6 months
over 6 months
You will be eating 6 meals per day spaced every 2½ – 3 hours. Do you feel that you will be able to do this consistently with work/school and any other commitments you have?
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Yes
No
Where did you hear about this?
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Magazine
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Other
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